42 C.F.R. § 422.576
Effect of an organization determination
The organization determination is binding on all parties unless it is reconsidered under §§ 422.578 through 422.596 or is reopened and revised under § 422.616.
Notes of Decisions
Cited in 7
cases (1 in the last 5 years), 2006–2022 · leading case: Humana Medical Plan, Inc. v. Western Heritage Insurance Company
Humana Medical Plan, Inc. v. Western Heritage Insurance Company (2016)
“See 42 C.F.R. § 422.576 . Even if Western retains the right to dispute the amount, its argument regarding Ms.”
Global Rescue Jets, LLC v. Kaiser Foundation Health Plan (2022)
“See 42 C.F.R. § 422.576 . Excusing exhaustion of administrative remedies would interfere with the agency’s opportunity to review those claims.”
Haaland v. Presbyterian Health Plan, Inc. (2018)
“§ 405 (g) - (h) ; 42 C.F.R. § 422.576 . This administrative channeling requirement serves important governmental interests in administrative efficiency and judicial economy, and it protects administrative agency authority, giving agencies an opportunity to correct their own…”
Humana Medical Plan, Inc. v. Reale (2015)
“23 42 C.F.R. § 422.576 (2009). 34 (the “MSP Act”),24 and reimbursement under Mrs.”
Matthews v. Leavitt (2006)
“612 (1998) (repealed) (organization determinations binding unless reconsideration sought); 42 C.F.R. § 422.576 (2006) (currently applicable analogous provision); see also 42 C.”
Honey v. Bayhealth Medical Center, Inc. (2015)
“23 Reed, supra at *7 (citing 42 C.F.R. § 422.576 (organizational determination); 42 C.”
Humana Medical Plan, Inc. v. Reale (2015)
“Reale’s Gold Plus HMO plan as 23 42 C.F.R. § 422.576 (2009). 24 42 U.S.C. § 1395y(b) (2009), discussed in detail below.”
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