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 I—Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B)

42 C.F.R. § 405.922

Time frame for processing initial determinations

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

The contractor issues initial determinations on clean claims within 30 calendar days of receipt if they are submitted by or on behalf of the beneficiary who received the items and/or services; otherwise, interest must be paid at the rate specified at 31 U.S.C. 3902(a) for the period beginning on the day after the required payment date and ending on the date payment is made.

[70 FR 11472, Mar. 8, 2005, as amended at 74 FR 65333, Dec. 9, 2009]
Notes of Decisions
Cited in 4 cases (1 in the last 5 years), 2012–2022 · leading case: Ctr. for Dermatology & Ski v. Sylvia Mathews Burwell, 770 F.3d 586 (7th Cir. 2014).
Sort: Relevance Newest Treatment
Ctr. for Dermatology & Ski v. Sylvia Mathews Burwell, 770 F.3d 586 (7th Cir. 2014). · cites it 3× “See 42 C.F.R. 405.922. A “clean claim” is one “that has no defect or impropriety (including any lack of any required substantiating documentation) or particular circumstance requiring special treatment that prevents timely payment[.”
S. Rehab. Grp. v. Sebelius, 874 F. Supp. 2d 733 (E.D. Tenn. 2012). “-, see 42 C.F.R. § 405.922 (interest on clean claims payable when initial claim determination is not made promptly).”
Vein & Wellness Grp., LLC v. Becerra (D. Maryland 2022). “The Centers for Medicare and Medicaid Services’ (“CMS”) contractor initially paid all the Medicare Part B claims at issue within thirty days of submission of the claims, as required by 42 C.F.R. § 405.922 . Id. In 2016, a Medicare contractor conducted a post-payment review of…”
Acute Care Ambulance Serv., LLC v. Alex M. Azar II (S.D. Tex. 2020). “”158 Until CMS or the contractor issue their initial determination, the provider is locked out of the administrative review scheme,159 which is a four-step administrative review process involving (1) a redetermination by a contractor, (2) a reconsideration by an independent…”
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.