U.S. Code of Federal Regulations
Regulations most recently checked for updates: Aug 27, 2025
A reconsideration reviewer must be someone who is—
(a) Qualified under § 476.98 of this chapter to make an initial determination.
(b) Not the individual who made the initial denial determination.
(c) A specialist in the type of services under review, except where meeting this requirement would compromise the effectiveness or efficiency of QIO review.