Advance Beneficiary Notices

The Centers for Medicare and Medicaid Services (CMS) issued an Advance Beneficiary Notice of Noncoverage (ABN) which took effect on January 1, 2012. Incyte Diagnostics has attached the latest version in both English and Spanish for your convenience. The bottom of the form should be dated 06/30/2023. Anything dated earlier will no longer be acceptable as of 8/31/2020.

A copy of the ABN instructions provided by CMS is available here. These instructions may be useful when updating your own ABNs. In addition, Noridian provides an interactive page that shows you how to properly complete the form. If you have any questions about these changes, please let your account representative know or call the Incyte Diagnostics Coding Line at 509.892.2784.

The instructions specify that the ABN must be verbally reviewed with the beneficiary or his/her representative and any questions raised during that review must be answered before it is signed. The ABN must be delivered far enough in advance that the beneficiary or representative has time to consider the options and make an informed choice. Once all blanks are completed and the form is signed, a copy is given to the beneficiary or representative. In all cases, the notifier must retain the original notice on file and a copy forwarded to Incyte Diagnostics.

Remember these FIVE fields to fill in for the ABN to be complete:

  1. Patient Name—VERY IMPORTANT
  2. Identification Number
  3. Choose Option 1, 2, or 3
  4. Patient Signature
  5. Date