GroundRules
42 CFR 476.83: Initial denial determinations.
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 F—QUALITY IMPROVEMENT ORGANIZATIONS
- PART 476—QUALITY IMPROVEMENT ORGANIZATION REVIEW
- Subpart C—Review Responsibilities of Quality Improvement Organizations (QIOs)
A determination by a QIO that the health care services furnished or proposed to be furnished to a patient are not medically necessary, are not reasonable, or are not at the appropriate level of care, is an initial denial determination and is appealable under part 473 of this chapter.
Collected 2026-08-27T02:26:11Z. Source file · JSON