Notice of Denial of Medical Coverage (NDMC), and the Notice of Denial of Payment (NDP) - 42 CFR 422.568 (CMS-10003)

Notice of Denial of Medical Coverage (NDMC), and the Notice of Denial of Payment (NDP) - 42 CFR 422.568

OMB: 0938-0829

IC ID: 8626

Information Collection (IC) Details

View Information Collection (IC)

Notice of Denial of Medical Coverage (NDMC), and the Notice of Denial of Payment (NDP) - 42 CFR 422.568 (CMS-10003)
 
No Modified
 
Mandatory
 
42 CFR 422.568

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction NDP Form Instructions - 2010 - 508.doc Yes No Printable Only
Form CMS 10003-NDP Notice of Denial of Payment NDP - 2010 - 508--07-21-10.doc Yes No Fillable Printable
Form CMS 10003-NDMC Notice of Denial of Medical Coverage NDMC - 2010 - 508--07-21-10.docx Yes No Fillable Printable
Instruction NDMC Form Instructions - 2010 - 508.doc Yes No Printable Only

Health Health Care Services

 

740 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,168,368 0 1,063,230 0 0 105,138
Annual IC Time Burden (Hours) 194,728 0 168,443 0 0 26,285
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
NDPforminstructionstrackchanges508 NDPforminstructionstrackchanges508.docx 07/16/2010
NDMCforminstructionstrackchanges508 NDMCforminstructionstrackchanges508.docx 07/16/2010
NDP - 2010 - 508--07-21-10-Track Changes NDP - 2010 - 508--07-21-10-Track Changes.doc 07/23/2010
NDMC - 2010 - 508--07-21-10-Track Changes NDMC - 2010 - 508--07-21-10-Track Changes.docx 07/23/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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