42 CFR 405.920 : Public Health (Part 1 To Parts 1009-1099) — (Subpart A To § 413.355) — Centers For Medicare & Medicaid Services, Department Of Health And Human Services (Subpart A To § 413.355) — Medicare Program (Subpart A To § 413.355) — Federal Health Insurance For The Aged And Disabled (Subpart A To § 405.2472) — Determinations, Redeterminations, Reconsiderations, And Appeals Under Original Medicare (Part A And Part B) (§ 405.900 To § 405.1140) — Initial Determinations (§ 405.920 To § 405.928) — Initial determinations.

4 Aug 2016

After a claim is filed with the appropriate contractor in the manner and form described in subpart C of part 424 of this chapter, the contractor must -

(a) Determine if the items and services furnished are covered or otherwise reimbursable under title XVIII of the Act;

(b) Determine any amounts payable and make payment accordingly; and

(c) Notify the parties to the initial determination of the determination in accordance with § 405.921.

42 CFR 405.920