42 C.F.R. § 476.85

Current through October 31, 2024
Section 476.85 - Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations

A QIO initial denial determination or change as a result of DRG validation is final and binding unless, in accordance with the procedures in part 473-

(a) The initial denial determination is reconsidered and revised; or
(b) The change as a result of DRG validation is reviewed and revised.

42 C.F.R. §476.85