Termination of Services

Notice of Termination of Services for SNF, HHA, CORF

When MediGold has authorized coverage of services, MediGold is responsible for determining a member's coverage termination date and providing a detailed explanation of termination of services as described in Chapter 13 section 90.7 of the Medicare Managed Care Manual CMS.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c13.pdf.

  • MediGold will coordinate with SNFs, HHAs and CORFs by providing a termination of services date as early in the day as possible to allow for timely delivery of the NOMNC.
  • If the SNF, HHA or CORF assesses a member to be appropriate for discontinuation of services or discharge, they will reach out to MediGold three days before the targeted termination date (also known as last covered day). MediGold will review the case with the provider to determine if services will continue or terminate.
  • If a member files an appeal, the plan must deliver a detailed explanation of why services should end. The two notices used for this purpose are:
  • Notice of Medicare Non-Coverage (NOMNC) Form CMS-10123-NOMNC.
  • Detailed Explanation of Non-Coverage (DENC) Form CMS-10124-DENC.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Updated 01/2019