US · guidance
CMS Pub. 100-04, ch. 30, § 260.4.3
Untimely Requests for Review
If the beneficiary makes an untimely request to the QIO, the QIO will accept the request
for review, but is not required to complete the review within its usual 72-hour deadline.
The QIO will make a determination as soon as possible upon receipt of the request.
Beneficiaries have up to 60 days from the effective date of the NOMNC to make an
untimely request to a QIO. When the beneficiary is still receiving services, the QIO must
make a determination and notify the parties within 7 days of receipt of the request. When
the beneficiary is no longer receiving services, the QIO will make a determination within
30 days of the request.
The coverage protections discussed in 260.4.2 do not apply to a beneficiary who makes
an untimely request to the QIO.
History
(Rev. 2711, Issued: 05-24-13, Effective: 08-26-13, Implementation: 08-26-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
934232a4e5c56b8e1f5e5f10af8d0c31b8ad7ac6d636c0c531c7e2ecbeb3371c
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