Other Considerations in the Notice of Medicare Non-Coverage (NOMNC) Process

Providers should also be aware of the following when notifying a member that their services are ending:

• Contracted facilities should be using the appropriate NOMNC forms. Providers should insert their name, address and phone number in the spaces provided at the top of the form.
• Blue Cross and Blue Shield of Nebraska (BCBSNE) may issue a next review date when authorizing skilled nursing facility (SNF) services. The next review date does not mean BCBSNE is denying further coverage.  
• Providers should submit an updated clinical review on the next review date. If upon review of the updated clinical information a denial decision is given, BCBSNE will allow for two additional days for the provider to supply the member with the NOMNC. The form should only be given to members when SNF criteria are no longer met and no further days are authorized by BCBSNE or two days prior to a scheduled discharge date.  
• If there is a change in the member’s condition after the NOMNC is issued, both BCBSNE and providers should consider the new clinical information. If there is a change in the effective date that coverage ends, the provider should inform the member that services will continue. The provider must then inform the member of the new coverage end date either through delivery of a new or amended NOMNC at least two days before services end.