Part 421 - Medicare Contracting  


Subpart A - Scope, Definitions, and General Provisions
§ 421.1 - Basis, applicability, and scope.
§ 421.3 - Definitions.
§ 421.5 - General provisions.
Subpart B - Intermediaries
§ 421.100 - Intermediary functions.
§ 421.103 - Payment to providers.
§ 421.104 - Assignment of providers of services to intermediaries during transition to Medicare Administrative Contractors (MACs).
§ 421.105 - Notification of action on nomination.
§ 421.106 - Change to another intermediary or to direct payment.
§ 421.110 - Requirements for approval of an agreement.
§ 421.112 - Considerations relating to the effective and efficient administration of the program.
§ 421.114 - Assignment and reassignment of providers by CMS.
§ 421.116 - Designation of national or regional intermediaries.
§ 421.117 - Designation of regional and alternative designated regional intermediaries for home health agencies and hospices.
§ 421.118 - Awarding of experimental contracts.
§ 421.120 - Performance criteria.
§ 421.122 - Performance standards.
§ 421.124 - Intermediary's failure to perform efficiently and effectively.
§ 421.126 - Termination of agreements.
§ 421.128 - Intermediary's opportunity for hearing and right to judicial review.
Subpart C - Carriers
§ 421.200 - Carrier functions.
§ 421.201 - Performance criteria and standards.
§ 421.202 - Requirements and conditions.
§ 421.203 - Carrier's failure to perform efficiently and effectively.
§ 421.205 - Termination by the Secretary.
§ 421.210 - Designations of regional carriers to process claims for durable medical equipment, prosthetics, orthotics and supplies.
§ 421.212 - Railroad Retirement Board contracts.
§ 421.214 - Advance payments to suppliers furnishing items or services under Part B.
Subpart D - Medicare Integrity Program Contractors
§ 421.300 - Basis, applicability, and scope.
§ 421.302 - Eligibility requirements for Medicare integrity program contractors.
§ 421.304 - Medicare integrity program contractor functions.
§ 421.306 - Awarding of a contract.
§ 421.308 - Renewal of a contract.
§ 421.310 - Conflict of interest requirements.
§ 421.312 - Conflict of interest resolution.
§ 421.316 - Limitation on Medicare integrity program contractor liability.
Subpart E - Medicare Administrative Contractors (MACs)
§ 421.400 - Statutory basis and scope.
§ 421.401 - Definitions.
§ 421.404 - Assignment of providers and suppliers to MACs.
Subpart F - XXX
§ 421.500 - Medicare review function.
§ 421.501 - Definitions.
§ 421.505 - Termination and extension of non-random prepayment complex medical review.