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Code of Federal Regulations (Last Updated: July 5, 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 |
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Subpart B - Utilization and Quality Control Peer Review Organization (PRO) Reconsiderations and Appeals |
§ 473.10 - Scope.
Latest version.
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This subpart establishes the requirements and procedures for—
(a) Reconsiderations conducted by a Utilization and Quality Control Peer Review Organization (PRO) or its subcontractor of initial denial determinations concerning services furnished or proposed to be furnished under Medicare;
(b) Hearings and judicial review of reconsidered determinations; and
(c) PRO review of a change in diagnostic and procedural coding information.