Notice of Medicare Non-coverage (NOMNC) Reporting
Provider Administrative Policy
DisclaimerOur provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.
The Centers for Medicare and Medicaid Services (CMS) requires all skilled nursing facilities (SNFs), home health agencies (HHAs) and comprehensive outpatient rehab facilities (CORFs) provide a Notice of Medicare Non-Coverage (NOMNC) to each patient at least two days prior to discontinuation of services. This notice informs the patient when their services will end, what Medicare appeal rights are available and how to request a fast track appeal.
When a denial is rendered based on medical necessity, Blue Cross of Idaho's Medical Management department works with the facility or agency and coordinates delivery of the NOMNC to the patient within the required timeframe. Although Medicare health plans are responsible for either making or delegating the decision to end services, SNFs, HHAs or CORFs are responsible for delivering the notices to patients or their authorized representative. Contracting providers not providing the notice of termination of services within the required timeframe, may be financially liable due to a denial based on medical necessity.
Termination Notice Delivery
If a member does not receive valid notice, their coverage continues for at least two days after they receive, sign and date their notification. is provided to the member for signature and date:
Methods of termination notice delivery in order of importance:
- In person
- By telephone
- By certified mail
In Person Notification
We require our medical management and SNF, HHA and CORF providers to use the standardized CMS notice.
The standardized notice must contain:
- The end date of coverage of services (at least two days prior to service termination).
- The date a member's financial liability begins (two days after providing notice and termination of services).
- A description of the member's right to a fast track appeal with the Quality Improvement Organization (QIO).
- How to contact the QIO.
- How to receive detailed information on why the member's coverage is ending.
To document receipt, the member must sign and date the notice they recieve.
If personal delivery is not immediately available, we may notify a member's authorized representative by telephone.
For telephone notification, the following is required:
- For a valid notification, the provider representative is required to adequately convey the termination of services.
- Documentation, including the date and time of the phone conversation, must be noted in the members record. The date of the phone conversation is considered the date of receipt of notice.
- Confirmation of telephone contact is required by sending written notification by certified mail the same day.
When phone contact is not possible, the provider should send the notice via certified mail with return receipt requested understanding that the following applies:
- The date of receipt is the date when someone at the address of record signs for the notification.
- If the post office returns the notification with no indication of a refusal date, member liability begins on the second working day after mailing the notice
Providers should maintain a copy of the NOMNC in the patient's medical record and fax a copy to Blue Cross of Idaho's Medical Management department using the contact information located in (MA PAP102)
|February 2011||Revised||Policy rewritten|