42 C.F.R. § 423.580

Right to a redetermination.

Last amended: 2018Year: 2026Length: 116 wordsOfficial source

Cite as 42 C.F.R. § 423.580 (2026)

An enrollee who has received a coverage determination (including one that is reopened and revised as described in § 423.1978) or an at-risk determination under a drug management program in accordance with § 423.153(f) may request that it be redetermined under the procedures described in § 423.582, which address requests for a standard redetermination. The prescribing physician or other prescriber (acting on behalf of an enrollee), upon providing notice to the enrollee, may request a standard redetermination under the procedures described in § 423.582. An enrollee or an enrollee's prescribing physician or other prescriber (acting on behalf of an enrollee) may request an expedited redetermination as specified in § 423.584. [83 FR 16752, Apr. 16, 2018]
Cross-references to the CFR
423.153423.1978423.582423.582.423.584.
42 C.F.R. § 423.580: Right to a redetermination. | Justis AI