naviHealth now completing NOMNC and DENC forms and providing them to skilled nursing facilities

We’ve changed the processes for completing the Notice of Medicare Non-Coverage form, also known as the NOMNC, and the Detailed Explanation of Non-Coverage form, also known as the DENC. Both forms are required by the Centers for Medicare & Medicaid Services for Medicare Advantage members.

Here’s what’s changing:

• naviHealth will now complete the NOMNC form and provide it to the skilled nursing facility before each member’s termination of services. The skilled nursing facility will continue to be responsible for delivering the form to the member.
• When the member appeals the termination of services decision, naviHealth will complete the DENC form and provide it to the skilled nursing facility. The facility will continue to be responsible for delivering the form to the member. naviHealth will also obtain the medical records and the valid signed NOMNC form from the skilled nursing facility. And it will send these documents, along with the DENC, to the Quality Improvement Organization.

We expect that these changes will help you comply with these government regulations.

Additional information you need to know
It’s crucial for skilled nursing facilities to deliver the NOMNC and DENC forms in a timely manner. Failure of the facility to deliver the NOMNC form to the member may result in the provider being held financially liable for the continued services until two days after the member receives a valid notice or until the effective date of the valid notice, whichever is later, per CMS 100-04 Chapter 30 §260.3.6. Providers may not balance bill the member for these services.

Background information
Skilled nursing facilities must notify Medicare beneficiaries about their right to appeal a termination of services decision. The facilities must do so by complying with requirements for providing the NOMNC form. This includes adhering to the time frames for delivery.

A valid DENC form must be provided to the Quality Improvement Organization when the organization notifies the skilled nursing facility about an appeal of a termination of the services. The form must be issued to the member and returned, along with the requested supporting documentation, to the QIO. Also, it must be returned within the established time frame set forth by the QIO in the notification to the provider of the appeal.

Copies of the NOMNC and DENC forms, and instructions are available here.**

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.