[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

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

[CITE: 42CFR478.18]



[Page 477-478]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 478_RECONSIDERATIONS AND APPEALS--Table of Contents

 

     Subpart B_Utilization and Quality Control Quality Improvement 

             Organization (QIO) Reconsiderations and Appeals

 

Sec.  478.18  Location for submitting requests for reconsideration.



    (a) Beneficiaries. Except as provided in paragraph (c) of this 

section concerning requests for expedited reconsideration, a beneficiary 

who wishes to



[[Page 478]]



obtain a reconsideration must submit a written request to one of the 

following:

    (1) The QIO or the QIO subcontractor that made the initial 

determination.

    (2) An SSA District Office.

    (3) A Railroad Retirement Board Office, if the beneficiary is a 

railroad retiree.

    (b) Others. A provider, physician or other practitioner that wishes 

to obtain reconsideration must submit a written request to the QIO or 

QIO subcontractor that made the initial determination.

    (c) Expedited reconsideration. A request for an expedited 

reconsideration of a preadmission denial determination must be submitted 

directly to the QIO.