GroundRules
42 CFR 423.2600: Payment appeals.
Where this section sits in the code
- Title 42—Public Health
- CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
- SUBCHAPTER B—MEDICARE PROGRAM
- PART 423—VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT
- Subpart Z—Appeals Process for Part D Program Integrity Prescription Drug Event Record Review Audits
Medicare Part D plan sponsors may appeal program integrity prescription drug event record review audit determinations.
(a) Issues eligible for appeal. (1) CMS's application of Part D policy(ies).
(2) Factual or data errors.
(b) Issues ineligible for appeal. (1) The Part D plan sponsor's failure to submit documentation in the timeframes specified by CMS during the audit.
(2) The program integrity prescription drug event record review audit methodology.
Collected 2026-08-27T02:26:11Z. Source file · JSON