Explanation for Nonsubstantive Change to OCN 0938-0829(NDMC)

Explanation for Nonsubstantive Change to OCN 0938-0829, Notice of Denial of Medical Coverage (NDMC) and the Notice of Denial of Payment (NDP)

Reference: CMS-10003, Notice of Denial of Medical Coverage (NDMC) (attached)

The current NDMC form, in the section titled “What Happens Next?” (page 2), includes the words “Medicare Advantage Organization” instead of the words “Medicare Health Plan”. The change in terminology from “Medicare Advantage Organization” to “Medicare Health Plan” in the NDMC was an oversight. The term “Medicare Health Plan” is a more inclusive term and is used in the Notice of Denial of Payment, the companion notice to the NDMC, as well as the corresponding NDMC and NDP form instructions and other notices and instructions used in the Medicare appeals process.

This change will make the terminology consistent among the various denial notices.