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MA Expedited Determination Notices

HHAs, SNFs, and CORFs are required to provide a Notice of Medicare Non-Coverage (NOMNC) to Medicare health plan enrollees when their Medicare covered service(s) are ending.  The NOMNC informs enrollees on how to request an expedited determination from their Quality Improvement Organization (QIO) and gives enrollees the opportunity to request an expedited determination from a QIO.  A Detailed Explanation of Non-Coverage (DENC) is given only if a beneficiary requests an expedited determination.  The DENC explains the specific reasons for the end of services.

Full instructions on the Medicare health plan expedited determination process, also known as the Medicare Advantage (MA) QIO fast track appeals process, are available in Chapter 13 of the Medicare Managed Care Manual,  Section 90.2 - 90.10, available below in 'Related Links'.

Plans currently are required to use the versions of the Medicare notices and instructions posted below, under 'Downloads'.

To download the Medicare health plan expedited determination Notices and Instructions (the NOMNC and DENC), please click on the appropriate link below.