Timeframes for Contractor Initiated Reopenings

10.6.1 - Timeframes for Contractor Initiated Reopenings (Rev. 3568, Issued: 07-29-16, Effective: 09-30-16, Implementation: 09-30-16) A contractor may reopen and revise its initial determination or redetermination on its own motion: • Within 1 year from the date of the initial determination or redetermination for any reason; or • Within 4 years from the date of the initial determination or redetermination for good cause as defined in §10.11; or • At any time if: o There exists reliable evidence that the initial determination was procured by fraud or similar fault as defined in 42 CFR 405.902; or o The initial determination is unfavorable, in whole or in part, to the party thereto, but only for the purpose of correcting a clerical error on which that determination was based. Third party payer error does not constitute clerical error as defined in §10.4; or, • At any time to effectuate a coverage decision issued under 42 CFR 426.460(b)(1)(i), 426.488(b) and (c) or 426.560 (b)(1)(i) appeals process.