The plan is required to automatically forward unfavorable redeterminations to the IRE

Submit any new evidence directly to the IRE for consideration

The IRE reviewer is an independent physician not affiliated with your plan

Medicaremoderate

Detailed Notice of Discharge (DND)

CMS-10066 · CMS

Explains why hospital services are ending and the patient's right to appeal. Issued when a patient requests an expedited review of discharge.

Form Details

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Where to Submit This Form

📬

Mail to the Independent Review Entity (IRE)

Your plan will forward the case automatically, or you can file directly with the IRE (currently Maximus Federal Services).

Filing Deadline

60 days from the date of the plan's unfavorable redetermination decision.

Required Attachments

📎 Copy of the plan's redetermination decision
📎 All prior appeal documentation and medical records
📎 Additional supporting clinical evidence
📎 Written argument detailing why the denial should be reversed

Processing Time

Standard: 30 days for Part C, 7 days for Part D. Expedited: 72 hours for Part D, 30 days for Part C.

What Happens Next

The IRE conducts an independent review of the entire case file. The IRE decision is binding on the plan. If unfavorable, further appeal to an ALJ is available.

Tips for This Form

✓ The plan is required to automatically forward unfavorable redeterminations to the IRE
✓ Submit any new evidence directly to the IRE for consideration
✓ The IRE reviewer is an independent physician not affiliated with your plan
✓ If the IRE overturns the denial, the plan must provide the service or drug within 72 hours (or 24 hours for expedited)

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