42 CFR §422.566(d)
September 3, 2020 3:47 amIf the MA organization expects to issue a partially or fully adverse medical necessity (or any substantively equivalent term used... View more
If the MA organization expects to issue a partially or fully adverse medical necessity (or any substantively equivalent term used... View more
(b) Timeframes – (1) Requests for service or item. Except as provided in paragraph (b)(1)(i) of this section, when a... View more
The notice of any denial under paragraph (d) of this section must – (1) Use approved notice language in a... View more
(g) Who must reconsider an adverse organization determination. (2) When the issue is the MA organization’s denial of coverage based... View more
(2) Limitation on recoupment (A) In general In the case of a provider of services or supplier that is determined... View more
(a) Hospital length of stay – (1) General rule. Except as provided in paragraph (a)(5) of this section, a group... View more
(1) Standard: Safeguards. A covered entity must have in place appropriate administrative, technical, and physical safeguards to protect the privacy... View more
(7) “Emergency care” means health care services provided in a hospital emergency facility… to evaluate and stabilize medical conditions of... View more
(7) “Emergency care” means health care services provided in a hospital emergency facility… to evaluate and stabilize medical conditions of... View more
(b) After a health maintenance organization has investigated a complaint, the health maintenance organization shall issue a response letter to... View more