Medicare Advantage Denial Notices

Medicare health plans must issue the Notice of Denial of Medical Coverage (or Payment) also known as the Integrated Denial Notice (IDN) Form CMS-10003-NDMCP when an enrollee's request for coverage is denied and when a previously authorized course of treatment has ended or been reduced. The IDN combines HMSA Akamai Advantage® coverage and payment denial notices and adds Medicaid appeal rights information when needed. Medicare plans were required to begin issuing the IDN as of November 1, 2013.

An IDN must be issued for the following situations since they’re not eligible for an expedited review:

• When beneficiaries never received Medicare-covered care in a covered setting (e.g., an admission to an SNF won’t be covered it wasn’t a qualifying hospital stay or a face-to-face visit wasn’t conducted for the initial episode of home health care).
• When services are being reduced (e.g., an HHA providing physical therapy and occupational therapy ends the occupational therapy).
• When beneficiaries are moving to a higher level of care (e.g., home health care ends because a beneficiary is admitted to an SNF).
• When beneficiaries use up their benefits (e.g., a beneficiary reaches 100 days in an SNF, thus exhausting their Medicare Part A SNF benefit).
• When beneficiaries end care on their own (e.g., a beneficiary revokes the hospice benefit and returns to standard Medicare coverage).
• When a beneficiary transfers to another provider at the same level of care (e.g., a beneficiary transfers from one SNF to another while remaining in a Medicare-covered SNF stay).
• When a provider ends care for business reasons (e.g., an HHA refuses to continue care at a home with a dangerous animal or the beneficiary was receiving physical therapy and the provider’s physical therapist leaves the HHA for another job).

The Office of Management and Budget (OMB) has approved revisions to the Notice of Denial of Medical Coverage (or Payment), also known as the Integrated Denial Notice (IDN). Plans should begin using the revised IDN  no later than May 1, 2023. 

[Integrated Denial Notice (NDMC) [DOCX]

Integrated Denial Notice (NDMC) [PDF]

Instructions for Integrated Denial Notice (NDMC) [PDF]

Revision History