The Centers for Medicare & Medicaid Services (CMS) has recently renewed the Notice of Medicare Non-Coverage (NOMNC, CMS-10123) and the Detailed Explanation of Non-Coverage (DENC, CMS-10124), effective for use beginning January 1, 2025.

While the same forms apply to both fee-for-service (FFS) Medicare beneficiaries and Medicare Advantage enrollees, the updated notices include new language specific to Medicare Advantage enrollees. These updates reflect regulations granting enrollees additional fast-track appeal rights if they submit an untimely appeal to the Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) or wish to appeal after ending services on or before the planned termination date. Presently, if a Medicare Advantage enrollee misses the deadline to appeal as stated on the NOMNC, the appeal is considered untimely, and the enrollee loses their right to a fast-track appeal to the BFCC-QIO.

Key Updates to the DENC Instructions

• Repeat Appeals in the Same Episode of Care: For enrollees who have previously received a favorable BFCC-QIO appeal decision during the current episode of care, health plans must now detail specific changes in the enrollee’s condition that justify the decision to terminate services.
• Transition Timeline:
  • Providers must continue using the current forms through December 31, 2024.
  • The new NOMNC and DENC must be used starting January 1, 2025.

The updated notices, including Spanish versions, are available here in the Downloads section.

For questions about the NOMNC and DENC, please contact the CMS Division of Appeals Policy.