US · guidance
CMS Pub. 100-16, ch. mc86c16a, § 90.3
Prior Notification
Under prior notification, a plan reduces its standard cost sharing levels when the provider
from whom a member is receiving plan-covered services voluntarily notifies the plan
prior to furnishing those services, or the member voluntarily notifies the plan prior to
receiving plan-covered services from a provider. PFFS plans may not require members
or providers to prior notify the plan as a condition of coverage nor can PFFS plans
establish voluntary prior notification rules.
History
(Rev. 99, Issued: 05-27-11, Effective: 05-27-11, Implementation: 05-27-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
c187000c89e89eef69a9d18ce2cfca8741998eed56ef8364ea6fea3bf072bab6
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