Timing of Denial Notice - (Rev. 4, 07-18-03)

7110 - Timing of Denial Notice - (Rev. 4, 07-18-03) Notify all affected parties within the mandatory timeframes for review completion (See 42 CFR 466.94) as follows (These timeframes do not apply to denials involving HINNs):  For preadmission denials, issue the notice before admission to the facility. If the patient is admitted before your medical review is completed, issue the notice by the first working day after the denial determination. At a minimum, maintain a detailed log that clearly indicates when denial notices are issued and to whom (complete patient identification).  For pre-procedure denials, regardless of whether the patient has been admitted, issue the notice before the procedure is performed.  For continued-stay denials, issue the notice by the first working day after the denial determination if the beneficiary is still in the facility. Deliver the notice to beneficiaries in the facility or mail the notice to those no longer in the facility. In addition, issue all notices simultaneously to all affected parties on a case-by-case basis as review determinations are made. Do not hold notices pending completion of a review cycle for notification to a provider, physician, or intermediary/carrier. Document if the denial notice is subsequently returned as undeliverable or receipt refused. Include the returned envelope and notice in the case file.