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Notices and Expedited Appeals

The Centers for Medicare & Medicaid Services (CMS) contracts with Stratis Health, as Minnesota's Quality Improvement Organization (QIO), to review expedited appeals that are requested by Medicare beneficiaries or their representatives.

The Beneficiary Notices Initiatives (BNI) Web site is the main source of information for providers. The Web site can clarify questions about the different notices used for all settings, with instructions for how to complete them. This Web site is also the main source of information about hospital issued notices of non-coverage (HINN).

Hospital Notices

Important Message (IM) from Medicare

The Important Message (IM) from Medicare is a notice that hospitals are required to give Medicare beneficiaries who are admitted into an acute inpatient status; notifying them about their hospital discharge appeal rights. It must be given and signed by a competent beneficiary or their representative within two (2) days of admission and again within two (2) days prior to discharge. If an appeal is requested, then a "Detailed Notice" will also need to be given.

Phone numbers for the Important Message. Use Stratis Health's Hospital Discharge Appeals phone number for expedited appeals on the Important Message to beneficiaries toll-free: 1-866-894-1327 and TYY/TTD number 1-800-627-3529. The dedicated line is only for use for hospital discharge appeals.

Hospital Requested Review (HRR)

When a hospital determines that a beneficiary no longer requires an acute level of inpatient care, but the attending physician does not agree, the hospital may request a QIO review of the medical record—known as a Hospital Requested Review (HRR). Hospitals must notify the beneficiary that the review has been requested.

For notices and instructions go to the BNI Web site and select "Hospital Discharge Appeals Notices" on the left side menu.

FFS HINNs

Fee-for-service (FFS) Medicare. A hospital issued notice of non-coverage (HINN) is a written notice issued by a hospital to a Medicare beneficiary for the purpose of assigning financial liability to the beneficiary. Hospitals have the authority to issue notices of non-coverage to beneficiaries if they determine that the care the beneficiary is about to receive (Pre-admission) or has been receiving (Admission) is not covered because it is not medically necessary, is not delivered in the most appropriate setting, or is custodial in nature.

The following HINN documents and instructions are on the BNI Web site under "FFS HINNs” on the left side menu. These are the current HINNs:

  • Pre-Admission/Admission HINN. When the hospital has determined at the time of preadmission or admission that a beneficiary’s stay will be a non-covered stay, the hospital may issue the preadmission/admission HINN.
  • HINN 11. This notice may be used to hold beneficiaries liable for certain non-covered services. The item or service at issue must be a diagnostic or therapeutic service excluded from Medicare coverage as medically unnecessary and the beneficiary must require continued inpatient hospital care.
  • HINN 12. HINN 12 is a liability notice and compliance with this notice does not fall under the review authority of the QIO.

A copy of the Pre-Admission/Admission HINN and HINN 12 is required to be issued to Stratis Health, Fax or mail. Fax 952-853-8586, Attn: Jodi.

Phone numbers for appeal of a HINN. Use Stratis Health's Helpine phone number on the Pre-Admission/Admission HINN to beneficiaries toll-free: 1-800-444-3423 and TYY/TTD number 1-800-627-3529. Do not use the dedicated hospital appeal line phone numbers.

Medicare Advantage Plan. If the beneficiaries have a Medicare Advantage Plan, call the individual plan for direction on the appropriate process or notice to be used to communicate financial liability.

More information

If you have questions regarding the Important Message or HINNs, call the toll-free provider line at 1-877-787-2847 to talk with a Stratis Health Case Review Manager. You may also email questions.

Non-Hospital Notices

If services provided by a Home Health Agency (HHA), Hospice, Skilled Nursing Facility (SNF), Swing Bed, or Comprehensive Outpatient Rehabilitation facility (CORF) are being discontinued, and if the beneficiary wants to appeal that decision, they are entitled to “fast-track” or “expedited” appeal. The following information, questions and answers, and notices with instructions on how to complete them can be found on the BNI Web site:

Medicare Fee for Service (FFS) Notices

The Notice of Medicare Provider Non-Coverage (NOMPNC)/ “The Generic Notice” would be the first notice to issue to a Medicare beneficiary with traditional Medicare coverage. If an appeal is requested then the Detailed Explanation of (Service type) Non-Coverage/ “The Detailed Notice” would also be issued.

Both of these notices can be found on the BNI Web site. From the left side menu select "FFS ED Notices" for the notices, instructions, questions and answers, and general information.

Medicare Advantage Notices

The Notice of Medicare Non-Coverage (NOMNC) is the first notices to issue to a Medicare beneficiary whose Medicare is being managed by a managed care health plan. If an appeal is requested then a Detailed Explanation of Non-Coverage (DENC) Notice would also need to be issued.

Both of these can be found on the BNI Web site. From the left side menu, select "MA ED Notices" for the notices, instructions, questions and answers, and general information.

Download a brochure and poster with more information on immediate appeals in non-hospital settings for Medicare beneficiaries and their representatives.

Phone numbers for NOMPNC and NOMNC. Use Stratis Health's dedicated non-hospital expedited appeal line phone number on the NOMPNC and NOMNC notices to Medicare beneficiaries toll-free: 1-877-624-1414 and TYY/TTD number 1-800-627-3529. The dedicated line is only for use for non-hospital expedited appeals.

More information

If you have questions regarding the NOMNC and NOMPNC or Detailed Explanation notices, call the toll-free provider line at 1-877-787-2847 to talk with a Stratis Health Case Review Manager or email.

Medicare Managed Care Manual. This manual provides more information about managed care notices and processes for appeals. At the end of the manual, in Appendix 7, the NOMNC and DENC are available in PDF format. (96-page PDF)

Medicare Internet Only Manuals. Find the Medicare Claims Processing Manual and other publications among the Internet-only manuals, which are replicas of the Agency's official record copy. They are CMS' program issuances, day-to-day operating instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives.