§478.24. Opportunity for a party to obtain and submit information.
42 C.F.R. § 478.24
Subject to the rules concerning disclosure of QIO information in section 1160 of the Act, at the request of a provider, practitioner or beneficiary, the QIO must provide an opportunity for examination of the material upon which the initial denial determination was based. The QIO may not furnish a provider, practitioner or beneficiary with—
A record of the QIO deliberation; or
The identity of the QIO review coordinators, physician advisors, or consultants who assisted in the initial denial determination without their consent.
The QIO may require the requester to pay a reasonable fee for the reproduction of the material requested.
The QIO must provide a party with an opportunity to submit new evidence before the reconsidered determination is made.
Notes, amendments, and revision history
Source
Source: 50 FR 15372, Apr. 17, 1985, unless otherwise noted. Redesignated at 64 FR 66279, Nov. 24, 1999.
Authority
Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).