---
kind: "range"
citation: "42 C.F.R. §§ 417.832–417.840"
title: "42"
from: "417.832"
to: "417.840"
count: 5
url: "https://uscodex.org/cfr/42/417.832..417.840"
---

# §417.832. Applicability of requirements and procedures.

- (a) The administrative review rights and procedures specified in [§§ 417.834 through 417.840](/cfr/42/417.834..417.840.md) pertain to disputes involving an organization determination, as defined in [§ 417.838](/cfr/42/417.838.md), with which the enrollee is dissatisfied.
- (b) Physicians and other individuals who furnish items or services under arrangements with an HCPP have no right of administrative review under [§§ 417.834 through 417.840](/cfr/42/417.834..417.840.md).
- (c) The provisions of [part 405](/cfr/42/part405.md) dealing with the representation of parties apply to organization determinations and appeals.
- (d) The provisions of [part 405](/cfr/42/part405.md) dealing with administrative law judge hearings, Medicare Appeals Council review, and judicial review are applicable, unless otherwise provided.

# §417.834. Responsibility for establishing administrative review procedures.


The HCPP is responsible for establishing and maintaining the administrative review procedures that are specified in [§§ 417.830 through 417.840](/cfr/42/417.830..417.840.md).


# §417.836. Written description of administrative review procedures.


Each HCPP is responsible for ensuring that all Medicare enrollees are informed in writing of the administrative review procedures that are available to them.


# §417.838. Organization determinations.

- (a) **Actions that are organization determinations.** For purposes of [§§ 417.830 through 417.840](/cfr/42/417.830..417.840.md), an organization determination is a refusal to furnish or arrange for services, or reimburse the party for services provided to the beneficiary, on the grounds that the services are not covered by Medicare.
- (b) **Actions that are not organization determinations.** The following are not organization determinations for purposes of [§§ 417.830 through 417.840](/cfr/42/417.830..417.840.md):
  - (1) A determination regarding services that were furnished by the HCPP, either directly or under arrangement, for which the enrollee has no further obligation for payment.
  - (2) **A determination regarding services that are not covered under the HCPP's agreement with CMS.**

# §417.840. Administrative review procedures.


The HCPP must apply [§ 422.568](/cfr/42/422.568.md) through [§ 422.626](/cfr/42/422.626.md) of this chapter to—

- (a) Organization determinations and fast-track appeals that affect its Medicare enrollees; and
- (b) Reconsiderations, hearings, Medicare Appeals Council review, and judicial review of the organization determinations and fast-track appeals specified in [paragraph (a)](#a) of this section.