GN 04060.015 Who May Reopen an Initial, Revised, Reconsidered, or Reviewed Determination or a Hearing Officers Decision
A. Part A Claims
The Health Care Financing Administration or an intermediary may reopen a Part A initial, revised, or reconsidered determination. However, an intermediary may reopen such a determination only if the last action on the determination was taken by the intermediary (i.e., a determination has not been made by an ALJ, Appeals Council, or a court).
B. Part B Claims
A Part B initial, revised, or reviewed determination may be reopened only by an intermediary or carrier. A decision by a hearing officer (HO) may be reopened only by an HO.