45 CFR 800.502
§ 800.502 MSP issuer internal claims and appeals.
United States · 45 CFR — Public Welfare · Status: effective
Cite this
- Citation
- 45 CFR 800.502, § 800.502 MSP issuer internal claims and appeals, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/220026
- Permanent ID
ys:prov:220026@1- SHA-256
062311ed0800a221671308204b373ca221cc827e4df64cbe4f2fe8034def75e7
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Full text
(a) Processes. MSP issuers must comply with the internal claims and appeals processes applicable to group health plans and health insurance issuers under 45 CFR 147.136(b).
(b) Timeframes and notice of determination. An MSP issuer must provide written notice to an enrollee of its determination on a claim brought under paragraph (a) of this section according to the timeframes and notification rules under 45 CFR 147.136(b) and (e), including the timeframes for urgent claims. If the MSP issuer denies a claim (or a portion of the claim), the enrollee may appeal the adverse benefit determination to the MSP issuer in accordance with 45 CFR 147.136(b).
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.