Revised Medicare Non-Coverage Notices Issued

The Office of Management and Budget (OMB) has renewed the Notice of Medicare Non-Coverage (NOMNC, CMS-10123), and the Detailed Explanation of Non-Coverage (DENC, CMS-10124). The NOMNC and DENC renewed notices contain updates which are applicable only to Medicare Advantage (MA) enrollees. Providers must use the current notices until December 31, 2024, and are required to use the new NOMNC and DENC beginning January 1, 2025. 

The NOMNC has been modified to reflect regulations providing MA enrollees additional fast-track appeal rights when they untimely request an appeal to the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), or still wish to appeal after they end services on or before the planned termination date.  

Additionally, DENC and instructions have been updated to include a new element for health plans to complete along with special instructions for repeat appeals within the same episode of care.

HHAs, SNFs, Hospices, and CORFs are required to provide a NOMNC to beneficiaries when their Medicare covered service(s) are ending.  The NOMNC informs beneficiaries on how to request an expedited determination from their BFCC-QIO and gives beneficiaries the opportunity to request an expedited determination from a BFCC-QIO.  A DENC is given only if a beneficiary requests an expedited determination.  The DENC explains the specific reasons for the end of covered services.

The revised notices can be found on the Beneficiary Notice Initiative website and are the last four links in the download section.