All Medicare Advantage Organizations (MAOs), including providers and delegated participating physician groups (PPGs) must issue the Integrated Denial Notice (IDN) - Notice of Denial of Medical Coverage (NDMC) letter to members when the delegated PPG denise in whole or in part, a request for a medical service/item. This may include cases when the delegated PPG denies a medical service requested by the member. A decision must be made as expeditiously as the member's health condition requires. Refer to the Centers for Medicare & Medicaid (CMS) website at www.cms.gov for downloading CMS-approved templates.