C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED › Subpart H—Appeals Under the Medicare Part B Program

42 C.F.R. § 405.815

Submission of claims

Read at: eCFRecfr.gov CornellLII GovInfogovinfo.gov CasesGoogle Scholar

A provider or supplier succeeding in having its enrollment application denial or billing privileges revocation reversed in a binding decision, or in having its billing privileges reinstated, may submit claims to the CMS contractor for services furnished during periods of Medicare qualification, subject to the limitations in § 424.44 of this chapter, regarding the timely filing of claims. If the claims previously were filed timely but were rejected, they are considered filed timely upon resubmission. Previously denied claims for items or services furnished during a period of denial or revocation may be resubmitted to CMS within 1 year after the date of reinstatement or reversal.

Notes of Decisions
Cited in 7 cases, 1994–2004 · leading case: Long Island Ambulance, Inc. v. Thompson, 220 F. Supp. 2d 150 (E.D.N.Y 2002).
Sort: Relevance Newest Treatment
Long Island Ambulance, Inc. v. Thompson, 220 F. Supp. 2d 150 (E.D.N.Y 2002). · cites it 6× “Following the overpayment determination, the provider may request a fair hearing before the carrier, 42 C.F.R. §§ 405.815 , 405.821; a fair hearing before the ALJ, 42 C.”
Marsaw v. Trailblazer Health Enter., L.L.C., 192 F. Supp. 2d 737 (S.D. Tex. 2002). “42 C.F.R. § 405.815 . If the administrative law judge similarly denies the claim, the claimant may then seek review by the Appeals Council.”
Michigan Ass'n of Indep. Clinical Labs. v. Shalala, 52 F.3d 1340 (6th Cir. 1994). · cites it 3× “42 C.F.R. §§ 405.815 , 405.820 (1994). If the amount in controversy is “at least $100, but less than $500,” review is limited to a “fair hearing” conducted by the hearing officer designated, by the carrier.”
Maximum Comfort, Inc. v. Thompson, 323 F. Supp. 2d 1060 (E.D. Cal. 2004). “5 at 1335; see 42 C.F.R. §§ 405.815 , 405.821. It then appealed CIGNA’s decisions.”
Cnty. Ambulance Serv., Inc. v. Thompson, 218 F. Supp. 2d 309 (E.D.N.Y 2002). · cites it 3× “See 42 C.F.R. §§ 405.815 , 405.855. A party dissatisfied with the decision of the carrier hearing officer can request a hearing before an ALJ if the amount in controversy is $500 or more.”
Manakee Prof'l Med. Transfer Serv., Inc. v. Shalala, 71 F.3d 574 (6th Cir. 1995). “§§ 1395ff(b)(l)(C), (b)(2)(B); 42 CFR § 405.815 . If the claim is again denied, the claimant may seek review in the Appeals Council.”
Advanced Med. Tech., Inc. v. Shalala, 974 F. Supp. 417 (D.N.J. 1997). “42 C.F.R. § 405.815 , 817. Fourth, any appeal from the “fair hearing” is to the administrative law judge, 20 C.”
Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.