Advanced Beneficiary Notice of Non-coverage (ABN) and Appeals - Appeals Newsletter Part 5

Noridian's Appeals team has seen an increase in appeals that do not have the ABN form with the request, Without the ABN, the appeal decision will cause the liability to change to the providers. Frequently, we receive the ABN once the providers receive the shift in liability notice.

  • Noridian can no longer treat this as a Redetermination, and it must be sent to the Reconsideration contractor.
  • This increases the amount of time for your appeals to be finalized.
  • Adds work unnecessarily for our Appeals team and the Reconsideration contractor.

Action

Make sure you have your documentation available when creating an appeal. When a service is appealed that has a previously signed ABN, include a copy in the appeal request.

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