Home Heath

Carelon, who manages Anthem Medicare plans in our area, sent us an email notification that we must upload the NOMNC within 4 hours of it being delivered to the patient beginning December 1, 2025.  It further states that failure to comply with the NOMNC requirements may result in payment delays or withholdings and cites CMS FFS & MA NOMNC/DENC page.  I've attached the email in case you are interested. 

I do not understand how they are able to withhold or deny payment if we do not upload the NOMNC within 4 hours of delivery.  Carelon is our largest MA payer that denies authorizing us additional visits, thus requiring us to discharge.

I'm wondering how other agencies and EMRs are implementing/complying with this?  

Thank you in advance for your assitance!

 

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Lisa Reichert
Senior Accountant
Calumet County HHC/Hospice Agency
Chilton WI
+1 (920) 849-1432
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We also just received the notice and are wondering the same, whether Carelon actually has the authority to enforce this or if it's more of a procedural expectation on their part. From what I understand, CMS only requires timely delivery of the NOMNC to the patient, not a specific upload timeframe. I'm also curious how others are handling this in their EMRs and workflows. We've had similar challenges with authorizations for additional visits as well.

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Chris Pankratz
Masters in Home Care, LLC
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