Under the Medicare Advantage program, HHA, SNF, CORF are required to provide a Generic Notice to beneficiaries to alert them that Medicare covered item(s) and/or service(s) are ending and give enrollees the opportunity to request an expedited determination from a QIO.  A Detailed Notice is given when the QIO review is requested in order to provide more explanation on why coverage is ending.

To download the notices and instructions, please click on the appropriate link below.

Downloads
Notice of Medicare Non-Coverage (NOMNC) [pdf, 23KB] Instructions for NOMNC [pdf, 26KB] Detailed Explanation of Non-Coverage (DENC) [pdf, 25KB]  Instructions for DENC [pdf, 15KB]
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Page Last Modified: 07/17/2008 12:29:19 PM
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