Notifications to Members

Notice of termination of services for skilled nursing facility (SNF), home health agency (HHA), or comprehensive outpatient rehabilitation facility (CORF): A provider must issue advance written notice to enrollees before termination of services in a SNF, HHA or CORF.
    

Notice of Non-Coverage Medicare (NOMNC)

Form Instructions: Notice of Medicare Non-Coverage (NOMNC)

 

If an enrollee files an appeal, then the Plan must deliver a detailed explanation of why services should end.

Detailed Explanation of Non-Coverage
Form Instructions: Detailed Explanation of Non-Coverage

 

When to Deliver the NOMNC

MediGold must deliver a completed copy of the Notice of Medicare Non-Coverage (NOMNC) to members receiving covered skilled nursing, home health (including psychiatric home health), comprehensive outpatient rehabilitation facility, and hospice services. The NOMNC must be delivered at least two calendar days before Medicare covered services end or the second to last day of service if care is not being provided daily.

 

Providers must deliver the NOMNC to all beneficiaries eligible for the expedited determination process of the Medicare Claims Processing Manual and Chapter 13, Sections 90.2-90.9 of the Medicare Managed Care Manual. A NOMNC must be delivered even if the beneficiary agrees with the termination of services. Medicare providers are responsible for the delivery of the NOMNC. The provider must ensure that the beneficiary or representative signs and dates the NOMNC to demonstrate that the beneficiary or representative received the notice and understands that the termination decision can be disputed.

 

The NOMNC must be provided to MediGold within 5 business days of discharge.

 

Completed SNF and Part B therapies NOMNC's should be faxed to MediGold Health Services at: 614-234-7037 and a copy placed in the medical record. All other NOMNC's should be placed in the medical record.

For more details, please see our MediGold Provider Administrative Manual at: MediGold.com/For-Providers/Tools-and-Resources/Provider-Admin-Guide

 

Updated 10/2018