FFS & MA NOMNC/DENC

HHAs, SNFs, Hospices, and CORFs are required to provide a Notice of Medicare Non-Coverage (NOMNC) to beneficiaries when their Medicare covered service(s) are ending.  The NOMNC informs beneficiaries on how to request an expedited determination from their Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) and gives beneficiaries the opportunity to request an expedited determination from a BFCC-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 covered services.

• To download the NOMNC and DENC, please click on the appropriate link below in "Downloads".
• Full instructions for the Original Medicare, also known as Fee for Service (FFS), expedited determination process are available in Section 260, of Chapter 30 of the CMS Claims Processing Manual, available below in "Downloads".
• Full instructions for the Medicare health plan expedited determination process, also known as the Medicare Advantage (MA) fast track appeals process, are available in the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance, in Section 100, available below in "Downloads."

Questions?

Questions regarding the NOMNC and DENC can be submitted at: https://appeals.lmi.org