42 C.F.R. § 478.24

Current through October 31, 2024
Section 478.24 - Opportunity for a party to obtain and submit information
(a) Subject to the rules concerning disclosure of QIO information in section 1160 of the Act, at the request of a provider, practitioner or beneficiary, the QIO must provide an opportunity for examination of the material upon which the initial denial determination was based. The QIO may not furnish a provider, practitioner or beneficiary with-
(1) A record of the QIO deliberation; or
(2) The identity of the QIO review coordinators, physician advisors, or consultants who assisted in the initial denial determination without their consent.
(b) The QIO may require the requester to pay a reasonable fee for the reproduction of the material requested.
(c) The QIO must provide a party with an opportunity to submit new evidence before the reconsidered determination is made.

42 C.F.R. § 478.24