[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR411.53]



[Page 395]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 411_EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT

--Table of Contents

 

  Subpart D_Limitations on Medicare Payment for Services Covered Under 

                     Liability or No-Fault Insurance

 

Sec. 411.53  Basis for conditional Medicare payment in no-fault cases.



    A conditional Medicare payment may be made in no-fault cases under 

either of the following circumstances:

    (a) The beneficiary, or the provider or supplier, has filed a proper 

claim for no-fault insurance benefits but the intermediary or carrier 

determines that the no-fault insurer will not pay promptly for any 

reason other than the circumstances described in Sec. 411.32(a)(1). 

This includes cases in which the no-fault insurance carrier has denied 

the claim.

    (b) The beneficiary, because of physical or mental incapacity, 

failed to meet a claim-filing requirement stipulated in the policy.