42 C.F.R. § 411.53 : Public Health — CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES — MEDICARE PROGRAM — EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT — LIMITATIONS ON MEDICARE PAYMENT FOR SERVICES COVERED UNDER LIABILITY OR NO-FAULT INSURANCE — Basis for conditional Medicare payment in no-fault cases

(a) A conditional Medicare payment may be made in no-fault cases under either of the following circumstances:
(1) The beneficiary has filed a proper claim for no-fault insurance benefits but the intermediary or carrier determines that the no-fault insurer will not pay promptly for any reason other than the circumstances described in §411.32(a)(1). This includes cases in which the no-fault insurance carrier has denied the claim.
(2) The beneficiary, because of physical or mental incapacity, failed to meet a claim-filing requirement stipulated in the policy.
(b) Any conditional payment that CMS makes is conditioned on reimbursement to CMS in accordance with subpart B of this part.

42 C.F.R. §411.53

71 FR 9470, 2/24/2006