New Expedited Determination Notices Posted

Providers must start using new notices before May 1, 2012

All Medicare beneficiaries (including those who are enrolled in a Medicare health plan) receive a Generic Notice prior to termination of Medicare-covered skilled nursing facilities, home health, hospice, and comprehensive outpatient rehabilitation facility services.  The notice informs individuals of their right to an immediate, independent review of the proposed discontinuation of covered services.  A Detailed Notice is given when the QIO review is requested in order to provide more explanation on why coverage is ending.

 A new combined Notice of Medicare Non-Coverage will replace the CMS 10123 (Original Medicare notice) and the CMS 10095 (Medicare Advantage notice).  These specific notices are a requirement, effective now with a grace period to begin using by May 1, 2012.

 New notices have been published by CMS – links to the notices can be found below.  There is now only one set of notices, but they are posted on two separate pages (Original Medicare and MA), each with a link below.  Providers have until May 1, 2012 to begin using the NOMNC/DENC.  After May 1, the previous versions of the CMS-10123/23 and the CMS-10095 will be invalidated by the QIO.

 Please direct any questions on the new NOMNC to Janet Miller

 Primaris is the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid Services.  If you have questions about this change in the CMS Notices of Non-coverage and their requirements, contact the Primaris Clinical Review Department at 800-347-1016.