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Code of Federal Regulations Title 42. Public Health § 42.480.136 Disclosure to intermediaries and carriers

Current as of January 02, 2025 | Updated by Findlaw Staff

(a) Required disclosure. Except as specified in §§ 480.139(a) and 480.140 relating to disclosure of QIO deliberations and quality review study information, a QIO must disclose to intermediaries and carriers QIO information that relates to, or is necessary for, payment of claims for Medicare as follows:

(1) Review determinations and claims forms for health care services, furnished in the manner and form agreed to by the QIO and the intermediary or carrier.

(2) Upon request, copies of medical records acquired from practitioners or institutions for review purposes.

(3) QIO information about a particular patient or practitioner if the QIO and the intermediary or carrier (or CMS if the QIO and the intermediary or carrier cannot agree) determine that the information is necessary for the administration of the Medicare program.

(b) Optional disclosure. The QIO may disclose the information specified in paragraph (a) of this section to intermediaries and carriers without a request.

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Cite this article: FindLaw.com - Code of Federal Regulations Title 42. Public Health § 42.480.136 Disclosure to intermediaries and carriers - last updated January 02, 2025 | https://codes.findlaw.com/cfr/title-42-public-health/cfr-sect-42-480-136/

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