UniCare SecurityChoice Plan

Due to the Grijalva law, UniCare PFFS SecurityChoice Providers (SNF's, Rehabilitiation Facilities, Home Health Agentcies) are delegated the responsibility to issue Notice of Medicare Non-Coverage (NOMNC), Detailed Explanation of Non-Coverage (DENC) and Notices of Discharge and Medicare Appeal Rights letters.

To download templates of the NOMNC and DENC letters, click on one of the links below. Once the file is open, fill the appropriate information into the darkened fields. When you are done, click on the "File" menu at the top of the window and select "Save As" to save it as a MS Word document to your local computer.

Notice of Medicare Non-Coverage (NOMNC) Template

Detailed Explanation of Non-Coverage (DENC) Template

Click here to view the instructions* issued by the Centers for Medicare & Medicaid Services (CMS) on usage of the NOMNC letter.

Full education on Grijalva implementation is available on the following section of the CMS website:
http://cms.hhs.gov/healthplans/appeals/

Link to the Nationwide Directory of CMS Quality Improvement Organizations:
http://www.medqic.org/dcs/ContentServer?pagename=Medqic/MQGeneralPage/GeneralPageTemplate&name=QIO%20Listings

*The NOMNC instruction document is in the PDF format. In order to view and print this document, you must have Adobe Acrobat Reader. This software is available for FREE from the Adobe Acrobat Web site. Click the icon below to verify that your version of Acrobat Reader is the most current version available. Please note that UniCare does not provide Technical Support for Acrobat Reader Software. For technical support, contact Adobe. To view pdf files, you must have Adobe Acrobat® Reader® (available FREE from Adobe) installed.