September 25, 2013 IMPORTANT INFORMATION REGARDING THE NOTICE OF MEDICARE NON-COVERAGE (NOMNC) FORM In May, 2013 CMS prepared a notification that the Notice of Medicare Non-Coverage (NOMNC) form must include the Medicare patient number. In the past the Health Plan’s member number was used in this space. That is no longer acceptable practice with CMS. As our healthcare partners we seek to ensure compliance with CMS regulations when servicing our members. To that end, please make any necessary changes to ensure delivered NOMNC’s have the Medicare patient number on page #1 of the form. See notice: MLN Matters® Number: MM7903 Revised Related Change Request (CR) #: CR 7903 Related CR Release Date: May 24, 2013 Effective Date: August 26, 2013 Related CR Transmittal #: R2711CP Implementation Date: August 26, 2013 260.3.2 - Completing the NOMNC (Rev.2711, Issued: 05-24-13, Effective: 08-26-13, Implementation: 08-26-13) Providers must use the OMB-approved NOMNC (CMS-10123). Providers must type or write the following information in the corresponding blanks of the NOMNC: Patient name Medicare patient number Type of coverage (SNF, Home Health, CORF, or Hospice) Effective date (last day of coverage) Note: The effective date is always the last day beneficiaries will receive coverage for their services. Beneficiaries have no liability for services received on this date, but may face charges for services received the day following the effective date of the NOMNC for home health, hospice, and CORF services. Because SNFs cannot bill the beneficiary for services furnished on the day of (but before the actual moment of) discharge, beneficiaries may leave a SNF the day after the effective date and not face liability for such services. CMS has published the NOMNC form at the following internet site: http://cms.gov/Medicare/MedicareGeneral-Information/BNI/FFSEDNotices.html The NOMNC forms may also be found on our websites at www.healthplanofnevada.com or www.sierrahealthandlife.com, Click on Providers, then Online Provider Information. If you have any questions regarding this facsimile please contact Provider Services at (702) 242-7088 or (800) 745-7065, Monday – Friday from 8:00 AM to 5:00 PM PST.
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