[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR411.53]

[Page 316]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 411--EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT--Table of Contents
 
 Subpart D--Limitations on Medicare Payment for Services Covered Under 
                     Liability or No-Fault Insurance
 
Sec. 411.53  Basis for conditional Medicare payment in no-fault cases.

    A conditional Medicare payment may be made in no-fault cases under 
either of the following circumstances:
    (a) The beneficiary, or the provider or supplier, has filed a proper 
claim for no-fault insurance benefits but the intermediary or carrier 
determines that the no-fault insurer will not pay promptly for any 
reason other than the circumstances described in Sec. 411.32(a)(1). This 
includes cases in which the no-fault insurance carrier has denied the 
claim.
    (b) The beneficiary, because of physical or mental incapacity, 
failed to meet a claim-filing requirement stipulated in the policy.

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