42 C.F.R. § 478.24 Opportunity for a party to obtain and submit information.
Title 42 - Public Health
(a) Subject to the rules concerning disclosure of QIO information in section 1160 of the Act, at the request of a provider, practitioner or beneficiary, the QIO must provide an opportunity for examination of the material upon which the initial denial determination was based. The QIO may not furnish a provider, practitioner or beneficiary with— (1) A record of the QIO deliberation; or (2) The identity of the QIO review coordinators, physician advisors, or consultants who assisted in the initial denial determination without their consent. (b) The QIO may require the requester to pay a reasonable fee for the reproduction of the material requested. (c) The QIO must provide a party with an opportunity to submit new evidence before the reconsidered determination is made.
Title 42: Public Health
PART 478—RECONSIDERATIONS AND APPEALS
Subpart B—Utilization and Quality Control Quality Improvement Organization (QIO) Reconsiderations and Appeals
§ 478.24 Opportunity for a party to obtain and submit information.
