OMB approves revised denial notices

CMS recently posted a revised Integrated Denial Notice (IDN) and instructions approved by the Office of Management and Budget for Medicare health plans to issue to enrollees in the event of a coverage denial.

The revision instructs enrollees to provide a copy of the denial notice to their physician to ensure that the enrollee and physician discuss steps to take following the denial. The notice states that in the event that the physician makes a request on behalf of the enrollee, a copy of the decision will be sent to the doctor.

The revised notice and instructions provide information about determining whether services are covered by Medicare or Medicaid along with the criteria to consider when making such a determination and the notices which may need to be issued. There is also additional clarification on what must be included in denial rationale. Information on how enrollees can request an IDN in alternative formats is also available now.

The notice and instructions are available for download on the MA Denial Notices website.