Consumers
Your Right to Appeal a Medicare Provider Notice of Non-Coverage
You deserve to get the best health care possible, and Medicare wants to make sure you get that care. That's why certain kinds of health care providers must give you written "Notice of Non-Coverage" before your care ends, if Medicare is paying for it.
You should receive this notice if the care you are receiving from any of the following is going to stop:
- Hospital
- Skilled nursing facility or hospital "swingbed" (for people who are not sick enough for the hospital but still need full-time nursing care).
- Home health agency.
- Hospice.
- Comprehensive outpatient rehabilitation facility (a clinic for patients who no longer need full-time care but still need special treatment).
Once you receive a written notice, you can request a fast-track review if you think you still need care and that Medicare should continue to pay for it.
If you get a Notice of Medicare Provider Non-Coverage and would like Qualidigm to review your case, contact us at 1.800.553.7590.
The Fast-Track Appeals Process
Whenever you are discharged (or your services are stopped) from an inpatient hospital, home health agency, skilled nursing facility, comprehensive outpatient rehabilitation facility or hospice, you will get a notice that will tell you how to request an appeal. If you believe that your services are ending too soon, call Qualidigm for an expedited review of your plan or provider decision. Our professional staff will look at your case and decide if your services are eligible to continue under Medicare coverage.
Medicare Advantage plans are private health plans that contract with Medicare to provide managed health care services to Medicare members. Beneficiaries enrolled in a Medicare Advantage plan have the right to call Qualidigm toll-free at 1.800.553.7590 to appeal their plan’s decision to stop coverage of services from an inpatient hospital, home health agency, skilled nursing facility, comprehensive outpatient rehabilitation facility or hospice.
Timing is important. The notice from your health care provider or the Medicare Advantage plan will give you the date when your services will end. Call Qualidigm immediately for an expedited review. If you miss the timeframe for filing a fast-track appeal, the notice will also tell you about other appeal rights available through your Medicare Advantage plan.
To request a fast-track appeal, call Qualidigm toll-free at 1.800.553.7590, Monday through Sunday 8:30 am to 4:30 pm. You can also leave a message any time of the day or night.
