42 C.F.R. § 476.83 Initial denial determinations.
Title 42 - Public Health
A determination by a QIO that the health care services furnished or proposed to be furnished to a patient are not medically necessary, are not reasonable, or are not at the appropriate level of care, is an initial denial determination and is appealable under part 473 of this chapter.
Title 42: Public Health
PART 476—UTILIZATION AND QUALITY CONTROL REVIEW
Subpart C—Review Responsibilities of Utilization and Quality Control Quality Improvement Organizations (QIOs)
QIO Review Functions
§ 476.83 Initial denial determinations.
