FLASH: Medicare Advantage ABN Process

Medicare Advantage members sometimes request procedures that aren’t covered, such as nail trimmings, from their provider’s office. Our providers were requesting members sign Advance Beneficiary Notice (ABN) letters or other waivers of liability, which have members attest that they’ll be financially liable for these non-covered services. CMS does not allow use of these forms prior to the services being rendered for Medicare Advantage plans. As a result of this rule, providers were absorbing the cost of providing non-covered services.

In order for providers to bill members for non-covered services, these steps must be completed:

1. A preauthorization or Confirmation of Non-Covered Service request must be submitted for the service or procedure prior to the service being rendered and
2. A notice of denied services to the member is required prior to the services being rendered. Non-clinical staff can issue denials for Confirmation of Non-Covered Services.

The same process is used for services or procedures that are non-covered due to local coverage determinations (LCDs) or national coverage determinations (NCDs) or that exceed quantity or frequency limits.

Submit this request through Your Health Alliance for providers by filling out the Medical form under File at Health Alliance in the Request Preauthorization tab. If you need help finding or completing this form, contact your provider relations specialist.