CurrentSelectHealthPolicy N/A

Notice of Medicare Non-Coverage

Explains that Medicare coverage for specified current services will end on an indicated effective date, notifies members of potential financial liability, and describes immediate appeal rights and how to contact the QIO and SelectHealth for assistance. Affects SelectHealth Medicare beneficiaries receiving services slated to end.

Policy Summary

PayerSelectHealth

PolicyNotice of Medicare Non-Coverage

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionNotify the member of the effective date when Medicare coverage will end and explain appeal rights and potential financial liability.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

888-317-0891QIO contact

855-442-9900Plan contact

by noon day beforeAppeal deadline

decision by ~2 daysQIO timing

Coverage end notice and member appeal rights

Notice content and appeal criteria

Conditions and member rights relating to end of Medicare coverage:

ALL of the following

Medicare provider and/or health plan have determined Medicare probably will not pay for the member's current services after the listed effective date.
Member may have to pay for any services received after the effective date if coverage ends.
Member has the right to an immediate, independent medical review (appeal); services will continue during the appeal.
If member requests an appeal, the independent reviewer will consider the member's opinion and medical records; the member and reviewer each receive a detailed explanation after the appeal is requested.

Policy Summary

PayerSelectHealth

PolicyNotice of Medicare Non-Coverage

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionNotify the member of the effective date when Medicare coverage will end and explain appeal rights and potential financial liability.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider responsibilities and appeals process

Denial Risk

Notice and appeal initiation responsibilities

Notify the member in writing of the effective date when Medicare coverage for the current services will end; inform them they may be responsible for payment for services received after that effective date and explain their appeal rights and processes.

Include the effective date on the notice.
State that Medicare probably will not pay for the current services after the effective date.
Advise the member they may have to pay for any services received after the effective date.

Prior Authorization

Immediate appeal process — refer to QIO (Kepro) and continue services

If the member requests an immediate appeal, direct them to the Quality Improvement Organization (Kepro) and continue the services during the appeal; instruct the member to contact Kepro at 888-317-0891 (TTY 855-843-4776) and to file the request as soon as possible but no later than noon the day before the effective date.

Member must request the immediate appeal from the QIO (Kepro).
Appeal should be made as soon as possible, but no later than noon of the day before the effective date.
QIO decision timing: generally no later than two days after the effective date for Original Medicare (by the effective date for Medicare health plans).
Continue services while the immediate appeal is pending.

Key terms and dates

Quality Improvement Organization (QIO)

QIO definitionA Quality Improvement Organization (QIO) is the independent reviewer authorized by Medicare to review the decision to end these services.

QIO contactKepro: 888-317-0891 (TTY: 855-843-4776).

Where to request an immediate appealRequests must be made to the QIO; see notice for QIO phone number and instructions.

Effective date

Effective date definitionThe effective date is the date after which Medicare probably will not pay for the member's current services.

Displayed on noticeThe effective date is shown on the notice as 'The Effective Date Coverage of Your Current {Insert Type} Services Will End: {insert effective date}'.

Implication for coverage and appealsCoverage likely ends after the effective date; members have immediate appeal rights and can request review before that date to continue services during appeal.

OpenPayer

Notice of Medicare Non-Coverage

Coverage end notice and member appeal rights

Coding and member financial responsibility

Provider responsibilities and appeals process

Key terms and dates