View all text of Subpart B [§ 478.10 - § 478.48]
§ 478.28 - Qualifications of a reconsideration reviewer.
A reconsideration reviewer must be someone who is—
(a) Qualified under § 476.98 of this chapter to make an initial determination.
(b) Not the individual who made the initial denial determination.
(c) A specialist in the type of services under review, except where meeting this requirement would compromise the effectiveness or efficiency of QIO review.