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

ICR 201106-0938-016

OMB: 0938-0829

Federal Form Document

Forms and Documents
Document
Name
Status
Form
 Modified
Supplementary Document
2011-06-17
Supplementary Document
2011-06-17
Justification for No Material/Nonsubstantive Change
2011-06-17
Supplementary Document
2010-07-23
Supplementary Document
2010-07-23
Supplementary Document
2010-07-16
Supplementary Document
2010-07-16
Supporting Statement A
2011-06-17
IC Document Collections
IC ID
Document
Title
Status
8626 Modified
ICR Details
0938-0829 201106-0938-016
Historical Active 201011-0938-013
HHS/CMS
Notice of Denial of Medical Coverage (NDMC), and the Notice of Denial of Payment (NDP) - 42 CFR 422.568
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 06/20/2011
Retrieve Notice of Action (NOA) 06/20/2011
  Inventory as of this Action Requested Previously Approved
10/31/2013 10/31/2013 10/31/2013
1,168,368 0 1,168,368
194,728 0 194,728
0 0 0
Medicare health plans, including Medicare Advantage plans, cost plans, and Health Care Prepayment Plans (HCPPs), are required to issue written notice of denials of payment or services, in whole or in part, to their enrollees. The denial notice must include a statement in understandable language of the reasons for the denial and a description of the applicable reconsideration and appeals processes. The NDP and NDMC were developed to comply with the Section 1852(g)(1)(B) of the Social Security Act. Regulatory authority for the NDMC and NDP are found at 42 CFR 422.568, and 42 CFR 417.600(b). Also, 42 CFR 417.840 applies certain Subpart M notice and appeal rules to cost plans and HCPPs. Additionally, CMS recently published a final rule with comment, "Medicare Program; Medicare Advantage and Prescription Drug Benefit Programs: Negotiated Pricing and Remaining Revisions," which added language to 42 CFR 422.578 and 42 CFR 422.582. This rule permits a physician providing treatment to an enrollee, upon providing notice to the enrollee, to request a standard reconsideration of a pre-service request for reconsideration on the enrollee's behalf.
US Code: 42 USC 1395w-22 Name of Law: Implementation of Medicare Advantage Program
   Statute at Large: 18 Stat. 1852 Name of Statute: null
  
None
Not associated with rulemaking
No
1
IC Title Form No. Form Name
Notice of Denial of Medical Coverage (NDMC), and the Notice of Denial of Payment (NDP) - 42 CFR 422.568 (CMS-10003) CMS 10003-NDMC, CMS 10003-NDP, CMS-10003-NDMC-SP, CMS-10003-NDP-SP Notice of Denial of Medical Coverage ,   Notice of Denial of Payment ,   Aviso de Denegaci?n de Cobertura M?dica ,   Aviso de Denegaci?n de Pago
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,168,368 1,168,368 0 0 0 0
Annual Time Burden (Hours) 194,728 194,728 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
No
No
No
Uncollected
William Parham 4107864669
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/20/2011
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