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US · guidance

CMS Pub. 100-04, ch. 30, § 300.5

Coverage During an Expedited Reconsideration

activein force · 2026-08-25 – presentas-observed

When a beneficiary makes a timely request for an expedited determination, the provider

may not bill the beneficiary for any disputed services until the IRE makes its

determination. Beneficiary liability for continued services is based on the QIO’s decision.

History

(Rev. 1257, Issued: 05-25-07; Effective: 07-01-07; Implementation: 07-02-07)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
fcc1ea6b6e4a4bb0b452e2529a3d92e8f7101770903cd277e0824e14ac0d52e0
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