42 CFR 405.948 : 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) — Redeterminations (§ 405.940 To § 405.958) — Conduct of a redetermination.

4 Aug 2016

A redetermination consists of an independent review of an initial determination. In conducting a redetermination, the contractor reviews the evidence and findings upon which the initial determination was based, and any additional evidence the parties submit or the contractor obtains on its own. An individual who was not involved in making the initial determination must make a redetermination. The contractor may raise and develop new issues that are relevant to the claims in the particular case.

42 CFR 405.948