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 versions will be available soon. 

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