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Code of Federal Regulations (Last Updated: November 8, 2024) |
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Title 42 - Public Health |
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Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter D - State Children'S Health Insurance Programs (Schips) |
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Part 466 - UTILIZATION AND QUALITY CONTROL REVIEW |
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Subpart C - Review Responsibilities of Utilization and Quality Control Peer Review Organizations (PROs) |
Subpart C - Review Responsibilities of Utilization and Quality Control Peer Review Organizations (PROs)
| PRO Review Functions |
| § 466.83 - Initial denial determinations. |
| § 466.84 - Changes as a result of DRG validation. |
| § 466.85 - Conclusive effect of PRO initial denial determinations and changes as a result of DRG validations. |
| § 466.86 - Correlation of Title XI functions with Title XVIII functions. |
| § 466.88 - Examination of the operations and records of health care facilities and practitioners. |
| § 466.90 - Lack of cooperation by a health care facility or practitioner. |
| § 466.93 - Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation. |
| § 466.94 - Notice of PRO initial denial determination and changes as a result of a DRG validation. |
| § 466.96 - Review period and reopening of initial denial determinations and changes as a result of DRG validations. |
| § 466.98 - Reviewer qualifications and participation. |
| § 466.100 - Use of norms and criteria. |
| § 466.102 - Involvement of health care practitioners other than physicians. |
| § 466.104 - Coordination of activities. |
| General Provisions |
| § 466.70 - Statutory bases and applicability. |
| § 466.71 - PRO review requirements. |
| § 466.72 - Review of the quality of care of risk-basis health maintenance organizations and competitive medical plans. |
| § 466.73 - Notification of PRO designation and implementation of review. |
| § 466.74 - General requirements for the assumption of review. |
| § 466.76 - Cooperation with health care facilities. |
| § 466.78 - Responsibilities of health care facilities. |
| § 466.80 - Coordination with Medicare fiscal intermediaries and carriers. |
| § 466.82 - Continuation of functions not assumed by PROs. |