Service Denial Templates
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
In accordance with standards established by CMS, Medicare Advantage Organizations (MAOs), delegated participating providers and hospitals are required to issue service denial letters. CMS has specific service denial letter templates that delegated participating providers and hospitals are required to issue to a member when certain services are denied.
Refer to the ICE website at www.iceforhealth.org/library.asp to access the ICE/CMS approved service denial templates listed below:
- Integrated Denial Notification - Notice of Denial of Medical Coverage (IDN-NDMC) with instructions
- Detailed Notice of Discharge (DND)
- Detailed Explanation of Non-Coverage (DENC) with instructions
- Notice of Medicare Non-Coverage (NOMNC) with instructions
- Integrated Denial Notification - Notice of Denial of Payment (IDN-NDP)