Statutes, codes, and regulations
Code of Federal Regulations
Title 42 - PUBLIC HEALTHChapter IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICESSubchapter F - QUALITY IMPROVEMENT ORGANIZATIONSPart 476 - QUALITY IMPROVEMENT ORGANIZATION REVIEWSubpart C - REVIEW RESPONSIBILITIES OF QUALITY IMPROVEMENT ORGANIZATIONS (QIOS)
QIO REVIEW FUNCTIONS
Section 476.83 - Initial denial determinations

42 C.F.R. § 476.83

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Current through October 31, 2024
Section 476.83 - Initial denial determinations

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.

42 C.F.R. §476.83