FFS ED Notices

HHAs, SNFs, Hospices, and CORFs are required to provide a Generic Notice to beneficiaries to alert them that Medicare covered item(s) and/or service(s) are ending and give beneficiaries the opportunity to request an expedited determination from a QIO.  A Detailed Notice is given when the QIO review is requested in order to provide more explanation on why coverage is ending.

To download the FFS Expedited Determination Notices and Instructions, please click on the appropriate link below.

March 2012 - IMPORTANT UPDATE: 

ISSUANCE OF REVISED NOMNC and DENC, FORM CMS-10123 and CMS-10124

CMS is issuing a new combined Notice of Medicare Non-Coverage. This notice will replace the CMS 10123 (Original Medicare notice) and the CMS 10095 (Medicare Advantage notice).

This combined notice retains the form number of the current Original Medicare Notice (CMS 10123) and the name of the MA notice (Notice of Medicare Non-Coverage, or NOMNC).

CMS also is issuing a new Detailed Explanation of Non-Coverage, or DENC, with the form number CMS 10124.

Providers are required to issue the new combined notices as soon as possible, but no later than May 1, 2012.