Notice of Medicare Non-Coverage (NOMNC) Form

These forms are for Skilled Nursing Facilities, Comprehensive Outpatient Rehabilitation Facilities, and Home Health Providers. UPMC for Life participating providers may now use the UPMC Health Plan-specific Notice of Medicare Non-Coverage (NOMNC) forms required by CMS.

Medicare Advantage HMO and PPO Plans

• Pennsylvania – UPMC for Life (Pennsylvania)
• Ohio – UPMC for Life (Ohio)

Medicare Advantage Special Needs Plans (SNP)

• Pennsylvania – UPMC for Life Complete Care (HMO SNP)