Medicare Advantage Expedited Determination Notices

Effective March 14, 2017, facilities will be required to use the following revised forms for Medicare Advantage members:

(Facilities should insert their logo at the top of the form. The form is available in PDF format or as a Word document and can be accessed by clicking on the links below.)

Notice of Medicare Noncoverage (NOMNC)

The NOMNC (CMS-10123) is issued by the facility when the decision is made to terminate Skilled Nursing Facility (SNF), Home Health Agency (HHA) or Comprehensive Outpatient Rehabilitation Facility (CORF) services even if the member agrees that services should end.

Detailed Explanation of Noncoverage (DENC)

The DENC (CMS-10124) is issued by HMSA or facility when members appeal directly to the Quality Improvement Organization (QIO) about the reduction or discontinuation of their SNF, HHA or CORF services.

For more information, go to https://www.cms.gov/Medicare/Medicare-General-Information/BNI/MAEDNotices.html

CURRENT AS OF 08/03/2026

Revision History

Date	Nature of Revision
08/03/2026	Migrated to new platform