§1320c–4. Right to hearing and judicial review — Inbound Citations

Citations to 42 U.S.C. § 1320c–4 as a whole

• 42 U.S.C. § 1320c–3(a)(2)(C)

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  (C) such determination is changed as the result of any hearing or review of the determination under section 1320c–4 of this title; or
• 42 U.S.C. § 1320c–3(a)(3)(C)

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  (C) The discussion and review conducted under subparagraph (B)(ii) shall not affect the rights of a practitioner or provider to a formal reconsideration of a determination under this part (as provided under section 1320c–4 of this title).
• 42 U.S.C. § 1320c–3(a)(3)(D)

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  (D) The notification under subparagraph (A) with respect to services or items disapproved by reason of paragraph (1)(B) shall not occur until after—

  (i) the organization has notified the practitioner or provider involved of the determination and of the practitioner’s or provider’s right to a formal reconsideration of the determination under section 1320c–4 of this title, and

  (ii) if the provider or practitioner requests such a reconsideration, the organization has made such a reconsideration.

  If a provider or practitioner is provided a reconsideration, such reconsideration shall be in lieu of any subsequent reconsideration to which the provider or practitioner may be otherwise entitled under section 1320c–4 of this title, but shall not affect the right of a beneficiary from seeking reconsideration under such section of the organization’s determination (after any reconsideration requested by the provider or physician under clause (ii)).
• 42 U.S.C. § 1320c–3(a)(3)(D)(i)

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  (i) the organization has notified the practitioner or provider involved of the determination and of the practitioner’s or provider’s right to a formal reconsideration of the determination under section 1320c–4 of this title, and