Revised Determination or Decision

10.9 - Revised Determination or Decision (Rev. 1069, Issued: 09-29-06, Effective: 11-29-06, Implementation: 11-29-06) A revised determination or decision is one in which: • The end result is changed (e.g., a service previously found to be covered is now found not to be covered or the allowable charge for the service is determined to be incorrect); or • The end result is not changed, but a party might be disadvantaged by the revision (e.g., a request for payment on a claim previously disallowed because the services were not medically necessary and therefore subject to the limitation on liability provisions, is now to be disallowed on a basis that precludes consideration of limitation on liability).