---
kind: "section"
citation: "42 C.F.R. § 421.200"
title: "42"
number: "421.200"
heading: "Carrier functions."
url: "https://uscodex.org/cfr/42/421.200"
---

# §421.200. Carrier functions.


A contract between CMS and a carrier specifies the functions to be performed by the carrier. The contract may include any or all of the following functions:

- (a) Any or all of the program integrity functions described in [§ 421.304](/cfr/42/421.304.md) provided the following conditions are met:
  - (1) The carrier is continuing those functions under a contract entered into under section 1842 of the Act that was in effect on August 21, 1996.
  - (2) The functions do not duplicate work being performed under a Medicare integrity program contract, except that the function related to developing and maintaining a list of DME may be performed under both a carrier contract and a Medicare integrity program contract.
- (b) Receiving, disbursing, and accounting for funds in making payments for services furnished to eligible individuals within the jurisdiction of the carrier.
- (c) **Determining the amount of payment for services furnished to an eligible individual.**
- (d) Undertaking to adjust incorrect payments and recover overpayments when it is determined that an overpayment was made.
- (e) Furnishing to CMS timely information and reports that CMS requests in order to carry out its responsibilities in the administration of the Medicare program.
- (f) Maintaining records and making available to CMS the records necessary for verification of payments and for other related purposes.
- (g) Establishing and maintaining procedures under which an individual enrolled under Part B is granted an opportunity for a redetermination.
- (h) **Upon inquiry, assisting individuals with matters pertaining to a carrier contract.**
- (i) Serving as a channel of communication to and from CMS of information, instructions, and other material as necessary for the effective and efficient performance of a carrier contract.
- (j) **Undertaking other functions as mutually agreed to by CMS and the carrier.**

## Notes

### Amendments

[72 FR 48886, Aug. 24, 2007]

### Authority

Authority: 42 U.S.C. 1302 and 1395hh.

### Source

Source: 45 FR 42179, June 23, 1980, unless otherwise noted.

### Amendments

[72 FR 48886, Aug. 24, 2007]