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

U.S. Code of Federal Regulations

Regulations most recently checked for updates: Aug 28, 2025

View all text of Subpart C [§ 476.70 - § 476.170]

§ 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.