Prior Auth Required

10123 - Form CMS- , to the member no later than two (2) calendar days before the

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceForm CMS- , to the member no later than two (2) calendar days before the
Procedure / Service Description

HHA, CORF, or hospice, the provider is required to prepare and deliver a NOMNC, using - When a decision has been made to terminate Covered Services for a member in a SNF, HHA, CORF, or hospice, the provider is required to prepare and deliver a NOMNC, using Form CMS-10123, to the member no later than two (2) calendar days before the planned end of Medicare-covered services, in accordance with 42 C.F.R. § 422.624. CenCal CareConnect shall notify the provider of the service termination date with

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.