C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 422—MEDICARE ADVANTAGE PROGRAM › Subpart M—Grievances, Organization Determinations and Appeals

42 C.F.R. § 422.578

Right to a reconsideration

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Any party to an organization determination (including one that has been reopened and revised as described in § 422.616) may request that the determination be reconsidered under the procedures described in § 422.582, which address requests for a standard reconsideration. A physician who is providing treatment to an enrollee may, upon providing notice to the enrollee, request a standard reconsideration of a pre-service request for reconsideration on the enrollee's behalf as described in § 422.582. An enrollee or physician (acting on behalf of an enrollee) may request an expedited reconsideration as described in § 422.584.

[74 FR 1542, Jan. 12, 2009]
Notes of Decisions
Cited in 5 cases, 2005–2012 · leading case: Giesse v. Sec'y of the Dep't of Health & Human Servs., 522 F.3d 697 (6th Cir. 2008).
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Giesse v. Sec'y of the Dep't of Health & Human Servs., 522 F.3d 697 (6th Cir. 2008). · cites it 2× “§ 1395w-22(g)(2); 42 C.F.R. § 422.578 . A M+C organization typically has thirty days to issue a reconsidered decision, 42 C.”
Christus Health Gulf Coast v. Aetna, Inc., 167 S.W.3d 879 (Tex. App.—Houston [14th Dist.] 2005). “§ 1395w-22(g)(2)-(5); 42 C.F.R. §§ 422.578 -.626 (2003). Though this process is obviously designed to protect patients’ rights regarding decisions such as coverage, providers can have an interest as well.”
Matthews v. Leavitt, 452 F.3d 145 (2d Cir. 2006). “614 (1998) (repealed) (providing right to seek reconsideration of organization determinations); 42 C.F.R. § 422.578 (2006) (currently applicable analogous provision).”
Main & Assocs., Inc. v. Blue Cross, 90 So. 3d 158 (Ala. 2012). “” 42 C.F.R. § 422.578 . Therefore, Southern Springs is entitled to avail itself of the administrative procedures provided pursuant to the Medicare Act.”
Giesse v. Sec'y of the Dep't of Health & Human Servs., 476 F. Supp. 2d 734 (N.D. Ohio 2006). “§§ 1395w-22(g)(l)(A), 1395w-22g(2), and 1395w-22(g)(4); 42 C.F.R. §§ 422.578 , 422.564(d)(2), and 422.”
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.