Glossary
Denial Notice
A written notice from Medicare, an MA plan, Part D plan, TRICARE/WPS, or VA explaining what was denied, why, and how to appeal.
Also known as: Notice of Denial of Medical Coverage, NOMNC, IDN, ABN, denial letter
Quick answer
A denial notice is the formal document that starts the appeal clock. Common types include the Medicare Summary Notice (MSN, Original Medicare), the Notice of Denial of Medical Coverage (MA), the Notice of Medicare Non-Coverage (NOMNC, ending services), the Integrated Denial Notice (IDN, dual-eligible), the Advance Beneficiary Notice (ABN, pre-service warning), the Part D coverage determination letter, the TFL EOB from WPS, and VA decision letters.
Why it matters
Every denial notice contains three critical pieces of information: the reason, the deadline, and the address to file the appeal. Lose the notice and you may lose the appeal.
Why this matters at age 65
Retirees now receive notices from multiple systems simultaneously. Keep a single binder or digital folder organized by date and program.
When you'll encounter it
Any time coverage or payment is denied, reduced, or ending.
Impact on Medicare
MSN is the primary Original Medicare notice.
Impact on TRICARE For Life
TFL EOBs from WPS function as the TFL denial notice.
Impact on Medicare Advantage
Plans issue formal denial notices for organization determinations and reconsiderations.
VA Healthcare considerations
VA decision letters trigger separate VA appeal rights and deadlines.
Common misconceptions
- "A bill from a provider is a denial notice." — Bills are not appealable in themselves. You need the payer's denial notice to start an appeal.
Common mistakes to avoid
- Discarding MSNs because they 'look like junk mail.'
- Missing the deadline buried in the second or third page of the notice.
What should I do?
- 1Open every notice the day it arrives.
- 2Highlight the reason, the deadline, and the appeal address.
- 3Keep notices for at least two years.
Continue learning
— suggested by the knowledge graph- Common mistakes retired military make at 65 — and how to avoid themThe most expensive errors retired service members and spouses make during the Medicare and TFL transition, and the simple fixes for each.
- How Medicare and TRICARE For Life claims are paidThe mechanics of the Medicare-to-TFL crossover system — what providers do, what WPS does, and what to do if a claim gets stuck.
- Billing ErrorsMistakes — accidental or intentional — on Medicare or TFL claims, ranging from duplicate charges to outright fraud.
- Claim AppealThe formal process for asking Medicare or TFL to reconsider a denied or underpaid claim.
- Medical Necessity AppealAn appeal arguing that a denied service, drug, or device is clinically necessary based on the treating provider's documentation.
- Quality of Care ComplaintA complaint filed with the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) about the quality of medical care you received.
- WPS Claim ReconsiderationThe first-level review of a TRICARE For Life claim decision, filed with Wisconsin Physicians Service (WPS), the TFL contractor.
- Appointment of RepresentativeA signed form (CMS-1696) that authorizes another person — family member, attorney, or advocate — to file or pursue a Medicare appeal on your behalf.
- Balance BillingThe practice of a provider billing you for the difference between their charge and what insurance approved.
- Medicare denied a service. Can I appeal?Yes. The first level for Original Medicare is a Redetermination filed with the Medicare Administrative Contractor (MAC) within 120 days of the denial notice (MSN).
- Do I appeal to Medicare or to TFL?Appeal to whichever payer issued the denial. If Medicare denied, appeal Medicare. If WPS denied TFL's share, appeal to WPS.
- Why did I get a bill if I have Medicare and TFL?Usually because the claim didn't cross over, DEERS is out of date, the provider doesn't accept Medicare, or the service isn't covered. Don't pay until you understand which one.
- What is a Medicare Summary Notice (MSN)?A quarterly summary from Medicare listing every claim filed under your number — what Medicare approved, paid, and what you may owe. Compare it against your WPS TFL EOBs.
- What if Medicare paid but TFL didn't?Usually a DEERS issue or a crossover failure. Call WPS at 1-866-773-0404 with your Medicare claim number — they can manually process it.
Related glossary terms
Related Official Resources
Continue learning straight from the source. Every link below goes to an official government or DoD resource.
Last reviewed January 2026 against the 2026 Medicare & You and TRICARE For Life handbooks.