[Code of Federal Regulations]
[Title 42, Volume 3, Parts 430 to end]
[Revised as of October 1, 2000]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR480.136]

[Page 400]
 
                         TITLE 42--PUBLIC HEALTH
 
                         CHAPTER IV--HEALTH CARE
                        FINANCING ADMINISTRATION,
                        DEPARTMENT OF HEALTH AND
                       HUMAN SERVICES--(Continued)
 
PART 480--ACQUISITION, PROTECTION, AND DISCLOSURE OF PEER REVIEW INFORMATION--Table of Contents
 
  Subpart B--Utilization and Quality Control Peer Review Organizations 
                                 (PROs)
 
Sec. 480.136  Disclosure to intermediaries and carriers.

    (a) Required disclosure. Except as specified in Secs. 476.139(a) and 
476.140 relating to disclosure of PRO deliberations and quality review 
study information, a PRO must disclose to intermediaries and carriers 
PRO information that relates to, or is necessary for, payment of claims 
for Medicare as follows:
    (1) Review determinations and claims forms for health care services, 
furnished in the manner and form agreed to by the PRO and the 
intermediary or carrier.
    (2) Upon request, copies of medical records acquired from 
practitioners or institutions for review purposes.
    (3) PRO information about a particular patient or practitioner if 
the PRO and the intermediary or carrier (or HCFA if the PRO and the 
intermediary or carrier cannot agree) determine that the information is 
necessary for the administration of the Medicare program.
    (b) Optional disclosure. The PRO may disclose the information 
specified in paragraph (a) of this section to intermediaries and 
carriers without a request.