Qualifications of a reconsideration reviewer.

A reconsideration reviewer must be someone who is— (a) Qualified under § 476.98 of this chapter to make an initial determination. (b) Not the individual who made the initial denial determination. (c) A specialist in the type of services under review, except where meeting this requirement would compromise the effectiveness or efficiency of QIO review. [50 FR 15330, Apr. 17, 1985, as amended at 77 FR 68563, Nov. 15, 2012]