CurrentBlue Cross Blue Shield - South CarolinaPolicy N/A

Notice of Medicare Non-Coverage (NOMNC) delivery and requirements

This document governs when and how providers and Medicare plans must deliver the Notice of Medicare Non-Coverage (NOMNC) to beneficiaries receiving certain Medicare-covered services and outlines exceptions, content, and signature/delivery procedures.

Policy Summary

PayerBlue Cross Blue Shield - South Carolina

PolicyNotice of Medicare Non-Coverage (NOMNC) delivery and requirements

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionDeliver completed NOMNC to beneficiaries in covered settings at least two calendar days before Medicare-covered services end and obtain the beneficiary or representative signature and date.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2 calendar daysminimum advance delivery before services end

2 pagesrequired length of the NOMNC

4listed Medicare settings

yessignature required

NOMNC Coverage and Delivery Criteria

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NOMNC coverage and delivery criteria

Covered when ALL of the following are met: delivery timing, exceptions, form content, and signature/delivery procedures for the Notice of Medicare Non‑Coverage (NOMNC).

ALL of the following

NOMNC must be delivered at least two calendar days before Medicare‑covered services end or on the second‑to‑last day of service when care is not provided daily

ALL of the following

If the plan makes the decision to terminate covered services but the provider delivers the notice, the plan must provide the service termination date to the provider at least two calendar days before services end

ALL of the following

ONE of: Beneficiary never received Medicare‑covered care in the covered setting (e.g., SNF admission not covered due to lack of qualifying hospital stay or missing required face‑to‑face visit for home health).
Services are being reduced (e.g., discontinuation of one therapy discipline such as occupational therapy while others continue).
Beneficiary is moving to a higher level of care (e.g., home health ends because beneficiary is admitted to a SNF).

ALL of the following

The NOMNC must remain two pages (either two sides of one page or one side of two pages); it must not be condensed to one page; provider logo/contact may appear on top but required text may not be moved from page 1 to page 2 to accommodate logos or headers.
Providers may include information in the optional 'Additional Information' section relevant to the beneficiary's situation, but it does not substitute for the Detailed Explanation of Non‑Coverage (DENC) when that is required.
The name, address, and telephone number of the provider delivering the notice must appear above the title of the form; providers may fill in the beneficiary's unique medical record or other identification number but must not use the beneficiary HIC number.
The form must state the effective date and type of services that will end (home health, skilled nursing, CORF, or hospice) and the actual end date in no less than 12‑point type; handwritten entries must be at least 12‑point and legible.

ALL of the following

The beneficiary or the beneficiary's representative must sign and date the NOMNC on the signature line; if the enrollee or representative refuses to sign on delivery date, annotate the case file to indicate the delivery date.
Electronic issuance is allowed with the option for a paper copy; if a representative is not available, telephone notification plus mailed confirmation procedures (including certified mail where appropriate) apply.
If the form is mailed to a representative and returned with no refusal date, enrollee liability begins on the second working day after the provider's mailing date.

ALL of the following

The NOMNC must include QIO contact information (including TTY) for expedited appeals in at least 12‑point type.
If a member requests coverage when exceptions would otherwise preclude a NOMNC, the plan must issue CMS form 10003 Notice of Denial of Medical Coverage.

ALL of the following

The form contains the OMB control statement and an estimated time to complete (approximately 15 minutes).

Provider Delivery and Coordination Responsibilities

Documentation Required

Deliver NOMNC at least two calendar days before services end; plans must provide termination date when decision not delegated

Deliver a completed NOMNC to beneficiaries in covered settings at least two calendar days before Medicare-covered services end (or on the second-to-last day of service if care is not provided daily). If the plan, not the provider, makes the termination decision but the provider is delivering the notice, the plan must give the provider the service termination date at least two calendar days before services end.

The two-calendar-day advance requirement is not a 48-hour requirement.
The NOMNC must be delivered for beneficiaries receiving covered skilled nursing, home health (including psychiatric home health), comprehensive outpatient rehabilitation facility, and hospice services.

Key Definitions

NOMNC — Notice of Medicare Non‑Coverage (inv-05)

DefinitionNotice of Medicare Non‑Coverage (NOMNC): completed notice that must be delivered to beneficiaries receiving certain Medicare‑covered services

Delivery timingMust be delivered at least two calendar days before Medicare‑covered services end (or the second‑to‑last day if care is not provided daily)

Signature requirementProvider must ensure the beneficiary or representative signs and dates the NOMNC to document receipt and understanding; assistive devices may be used; electronic issuance allowed with option for paper copy

Covered settings (inv-06)

Covered settings (summary)Skilled nursing facility; home health (including psychiatric home health); comprehensive outpatient rehabilitation facility; hospice services

ScopeNOMNC delivery requirement applies to beneficiaries/enrollees receiving Medicare‑covered services in these settings

Timing noteThe two‑day advance requirement is not a strict 48‑hour rule (deliver at least two calendar days before services end)

OpenPayer

Notice of Medicare Non-Coverage (NOMNC) delivery and requirements

NOMNC Coverage and Delivery Criteria

Coding and Form Length

Provider Delivery and Coordination Responsibilities

Key Definitions