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Code of Federal Regulations (Last Updated: May 6, 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 473 - RECONSIDERATIONS AND APPEALS |
| Subpart B - Utilization and Quality Control Peer Review Organization (PRO) Reconsiderations and Appeals |
| § 473.10 - Scope. |
| § 473.12 - Statutory basis. |
| § 473.14 - Applicability. |
| § 473.15 - PRO review of changes resulting from DRG validation. |
| § 473.16 - Right to reconsideration. |
| § 473.18 - Location for submitting requests for reconsideration. |
| § 473.20 - Time limits for requesting reconsideration. |
| § 473.22 - Good cause for late filing of a request for a reconsideration or hearing. |
| § 473.24 - Opportunity for a party to obtain and submit information. |
| § 473.26 - Delegation of the reconsideration function. |
| § 473.28 - Qualifications of a reconsideration reviewer. |
| § 473.30 - Evidence to be considered by the reconsideration reviewer. |
| § 473.32 - Time limits for issuance of the reconsidered determination. |
| § 473.34 - Notice of a reconsidered determination. |
| § 473.36 - Record of reconsideration. |
| § 473.38 - Effect of a reconsidered determination. |
| § 473.40 - Beneficiary's right to a hearing. |
| § 473.42 - Submitting a request for a hearing. |
| § 473.44 - Determining the amount in controversy for a hearing. |
| § 473.46 - Departmental Appeals Board and judicial review. |
| § 473.48 - Reopening and revision of a reconsidered determination or a hearing decision. |