US · guidance
CMS Pub. 100-04, ch. 30, § 260.3.2
Completing the NOMNC
Providers must use the OMB-approved NOMNC (CMS-10123). Providers must type or
write the following information in the corresponding blanks of the NOMNC:
• Patient name
• Medicare patient number
• Type of coverage (SNF, Home Health, CORF, or Hospice)
• Effective date (last day of coverage)
Note: The effective date is always the last day beneficiaries will receive coverage for
their services. Beneficiaries have no liability for services received on this date, but may
face charges for services received the day following the effective date of the NOMNC for
home health, hospice, and CORF services. Because SNFs cannot bill the beneficiary for
services furnished on the day of (but before the actual moment of) discharge,
beneficiaries may leave a SNF the day after the effective date and not face liability for
such services.
History
(Rev. 2711, Issued: 05-24-13, Effective: 08-26-13, Implementation: 08-26-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
90b3c2c5aafbeb4622f5a999d387ff92a47b6cd451ba80aec09a20176da4ca7c
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