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Expedited Appeals for Medicare Beneficiaries

If you are receiving care from a skilled nursing facility, home health agency, comprehensive outpatient rehabilitation facility or hospice and disagree with their decision to end Medicare coverage, call our immediate appeal line at 1-800-748-6773.

• The healthcare provider must give you a Notice of Medicare Non-Coverage (NOMNC). This is a preliminary notice advising you when the services will end and providing you with information on your appeal rights and how to file an appeal.
• You must be given at least two days notice prior to termination of services.
• If you disagree with the notice, you must request an appeal
  BY NOON OF THE DAY PRIOR TO TERMINATION OF COVERAGE

HealthInsight will notify the healthcare provider that an appeal has been filed. The provider will then issue a Detailed Explanation of Non-Coverage (DENC) that provides an explanation of why services are either no longer necessary or covered. Copies of this notice are also sent to HealthInsight. The DENC must be delivered to you and HealthInsight by the close of business on the day the NOMNC is issued.

HealthInsight will request the available medical information and may contact the provider, you, and your physician for additional information. The medical record and any other pertinent information will be sent to an independent physician for review. If the appeal is requested timely, the determination will be made within 72 hours.

When the physician review is complete, HealthInsight will notify you and the healthcare provider of the case review determination, both verbally and in writing.

If HealthInsight reverses the original termination decision, your healthcare provider will give you a new notice your coverage will continue until the new date of termination issues a new notice with a new termination date.

If HealthInsight determines coverage should terminate on a given date, you will be liable for any services continued after that date, unless the decision by HealthInsight is reversed on reconsideration (second level appeal).

If you disagree with the initial determination by HealthInsight, you may request a reconsideration by contacting HealthInsight or the Qualified Independent Contractor (QIC).