Initial denial determinations.

1. Law
2. CFR 42
3. Public Health
4. Centers for Medicare & Medicaid Services, Department of Health and Human Services
5. Quality Improvement Organizations
6. Quality Improvement Organization Review
7. Review Responsibilities of Quality Improvement Organizations (QIOs)
8. QIO Review Functions
9. Initial denial determinations.

§ 476.83 Initial denial determinations.

A determination by a QIO that the health care services furnished or proposed to be furnished to a patient are not medically necessary, are not reasonable, or are not at the appropriate level of care, is an initial denial determination and is appealable under part 473 of this chapter.

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