Title 42, Part 421 — Medicare Contracting

Basis, applicability, and scope.

Definitions.

General provisions.

Intermediary functions.

Payment to providers.

Assignment of providers of services to intermediaries during transition to Medicare Administrative Contractors (MACs).

Requirements for approval of an agreement.

Considerations relating to the effective and efficient administration of the program.

Assignment and reassignment of providers by CMS.

Performance criteria.

Performance standards.

Intermediary's failure to perform efficiently and effectively.

Termination of agreements.

Intermediary's opportunity for hearing and right to judicial review.

Carrier functions.

Performance criteria and standards.

Requirements and conditions.

Carrier's failure to perform efficiently and effectively.

Termination by the Secretary.

Designations of regional carriers to process claims for durable medical equipment, prosthetics, orthotics and supplies.

Railroad Retirement Board contracts.

Advance payments to suppliers furnishing items or services under Part B.

Basis, applicability, and scope.

Eligibility requirements for Medicare integrity program contractors.

Medicare integrity program contractor functions.

Awarding of a contract.

Renewal of a contract.

Conflict of interest requirements.

Conflict of interest resolution.

Limitation on Medicare integrity program contractor liability.

Statutory basis and scope.

Definitions.

Assignment of providers and suppliers to MACs.