Title 42

SECTION 476.85

476.85 Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.

§ 476.85 Conclusive effect of QIO initial denial determinations and changes as a result of DRG validations.

A QIO initial denial determination or change as a result of DRG validation is final and binding unless, in accordance with the procedures in part 473 -

(a) The initial denial determination is reconsidered and revised; or

(b) The change as a result of DRG validation is reviewed and revised.

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