MA Denial Notice

What's New

11/18/2024: The Office of Management and Budget (OMB) has renewed the Notice of Denial of Medical Coverage (or Payment) (CMS-10003).  Medicare health plans must use the current notice until December 31, 2024, and are required to use the new notice beginning January 1, 2025. 

The updated notice and form instructions are available in the "Downloads" section below. The translated Spanish version is also available in the "Downloads" section below. 

12/20/2024 Update: This notice was released in November 2024, with revisions consistent with regulatory changes in CMS-4205-F, effective January 1, 2025. Medicare Advantage plans have expressed concern with implementing the revised notice close to the start of the 2025 plan year, given the need for programming and testing activities. As a result of these concerns, CMS will allow Medicare Advantage plans additional time to implement the revised IDN.  MA organizations must implement the IDN as soon as practicable, but no later than April 1, 2025. This extended deadline to implement the updated notice does not alter or amend the applicability date of the regulatory changes in CMS-4205-F. 

Overview

Medicare health plans are required to issue the Notice of Denial of Medical Coverage (or Payment), also known as the Integrated Denial Notice (IDN), upon denial, in whole or in part, of an enrollee's request for coverage and upon discontinuation or reduction of a previously authorized course of treatment. The IDN consolidates Medicare Advantage coverage and payment denial notices and integrates, where applicable, Medicaid appeal rights information for Medicare health plan enrollees receiving full benefits under a State Medical Assistance (Medicaid) program. Plans administering Medicaid benefits, in addition to Medicare benefits, are responsible for including applicable Medicaid information in the notice.

Medicare health plans and Fully Integrated Dual Eligible (FIDE) plans will issue the IDN to inform enrollees of their appeal rights, as applicable, upon denial of coverage of items and services, and for discontinuation or reduction of a previously authorized course of treatment. Medicare-Medicaid Plans (MMPs) within the Financial Alignment Demonstrations also will use the IDN.

To download the IDN and its corresponding instructions, please click on the links below under "Downloads."

Questions regarding the IDN can be submitted to: https://appeals.lmi.org