§ 405.920 Initial determinations
§ 405.921 Notice of initial determination
§ 405.922 Time frame for processing initial determinations
§ 405.924 Actions that are initial determinations
§ 405.925 Decisions of utilization review committees
§ 405.926 Actions that are not initial determinations
§ 405.927 Initial determinations subject to the reopenings process
§ 405.928 Effect of the initial determination
§ 405.929 Post-payment review
§ 405.930 Failure to respond to additional documentation request

Terms Used In CFR > Title 42 > Chapter IV > Subchapter B > Part 405 > Subpart I > Initial Determinations

  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Contract: A legal written agreement that becomes binding when signed.
  • Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.