42 C.F.R. § 478.28 Qualifications of a reconsideration reviewer.
Title 42 - Public Health
A reconsideration reviewer must be someone who is— (a) Qualified under §466.98 of this chapter to make an initial determination. (b) Not the individual who made the initial denial determination. (c) A specialist in the type of services under review, except where meeting this requirement would compromise the effectiveness or efficiency of QIO review.
Title 42: Public Health
PART 478—RECONSIDERATIONS AND APPEALS
Subpart B—Utilization and Quality Control Quality Improvement Organization (QIO) Reconsiderations and Appeals
§ 478.28 Qualifications of a reconsideration reviewer.
