Medicare Beneficiary Notices Initiative (BNI) MA Denial Notices
Guidance for Medicare health plans on required Notice of Denial of Medical Coverage (or Payment), also known as the Integrated Denial Notice (IDN).
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: March 30, 2020
UPDATE – March 13, 2023: The updated Spanish version of the IDN has been approved by OMB and is now available for download below. Plans should begin using this updated Spanish version no later than 60 days from the date of this update.
March 3, 2023: The Notice of Denial of Medical Coverage (or Payment), also known as the Integrated Denial Notice (IDN), has been updated to reflect the latest nondiscriminatory language required on CMS forms and notices. The OMB-approved standardized notice displays the new expiration date of 12-31-2024.
Medicare health plans are required to issue the Notice of Denial of Medical Coverage (or Payment), also known as the Integrated Denial Notice (IDN), upon denial, in whole or in part, of an enrollee's request for coverage and upon discontinuation or reduction of a previously authorized course of treatment. The IDN consolidates Medicare Advantage coverage and payment denial notices and integrates, where applicable, Medicaid appeal rights information for Medicare health plan enrollees receiving full benefits under a State Medical Assistance (Medicaid) program. Plans administering Medicaid benefits, in addition to Medicare benefits, are responsible for including applicable Medicaid information in the notice.
Medicare health plans and Fully Integrated Dual Eligible (FIDE) plans will issue the IDN to inform enrollees of their appeal rights, as applicable, upon denial of coverage of items and services, and for discontinuation or reduction of a previously authorized course of treatment. Medicare-Medicaid Plans (MMPs) within the Financial Alignment Demonstrations also will use the IDN.
To download the IDN and its corresponding instructions, please click on the links below under "Downloads."
Questions regarding the IDN can be submitted to: https://appeals.lmi.org
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.