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Detailed Explanation of Non-Coverage Form CMS-10124

Detailed Explanation of Non-Coverage Form

Item SKU # - CMS-10124
List Price: $24.10
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Use this detailed explanation of Non-Coverage when the beneficiary does not agree that the Medicare coverage should end, the beneficiary may request an expedited review of the termination decision by the Quality Improvement Organization (QIO) in their state.  The provider then must furnish the Detailed Explanation of Non-Coverage (Detailed Notice) to the beneficiary explaining why services are no longer being covered. 

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