Denial Patterns

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6.1 “WNL” alone

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Sources and clinical references

  • CMS Pub. 100-02 Chapter 8 (SNF coverage; daily-basis and practical-matter tests) and Pub. 100-08 (medical review / ADR).
  • 42 CFR Part 483 with State Operations Manual Appendix PP — F580; F604/F605; F636–F657; F641; F684; F686; F689; F692; F697; F758; F609/F610.
  • CMS MDS 3.0 RAI User’s Manual v1.20.1 (effective 1 Oct 2025). Notices: SNFABN CMS-10055, NOMNC CMS-10123, ABN CMS-R-131.
  • Jimmo v. Sebelius — the maintenance-coverage standard.
  • SawaOS DGEX-SNF Foundations (1.1–1.11) and the denial-and-survey-risk sections of the SNF reference modules — the sources of the extended patterns above.

Standing flags. Display numbers are provisional; the module code is the key. Notice and appeal requirements and qualifying-stay waivers change — verify against the current source. MAC/LCD and accreditation items are facility-fill.

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