Grievances, Coverage Determinations, Redeterminations, and Reconsiderations | Midpage

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Code of Federal Regulations

Subpart M

Grievances, Coverage Determinations, Redeterminations, and Reconsiderations

423.558Scope.423.560Definitions.423.562General provisions.423.564Grievance procedures.423.566Coverage determinations.423.568Standard timeframe and notice requirements for coverage determinations.423.570Expediting certain coverage determinations.423.572Timeframes and notice requirements for expedited coverage determinations.423.576Effect of a coverage determination.423.578Exceptions process.423.580Right to a redetermination.423.582Request for a standard redetermination.423.584Expediting certain redeterminations.423.586Opportunity to submit evidence.423.590Timeframes and responsibility for making redeterminations.423.600Reconsideration by an independent review entity (IRE).423.602Notice of reconsideration determination by the independent review entity.423.604Effect of a reconsideration determination.423.610-423.634[Reserved]423.636How a Part D plan sponsor must effectuate standard redeterminations, reconsiderations, or decisions.423.638How a Part D plan sponsor must effectuate expedited redeterminations or reconsiderations.