§ 405.920 - Initial determinations.  


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  • § 405.920 Initial determinations.

    After a claim is filed with the appropriate contractor in the manner and form described in subpart C of part 424 of this chapter, the contractor must -

    (a) Determine if the items and services furnished are covered or otherwise reimbursable under title XVIII of the Act;

    (b) Determine any amounts payable and make payment accordingly; and

    (c) Notify the parties to the initial determination of the determination in accordance with § 405.921.