Skip to main content

Centers for Medicare & Medicaid Services

CMS Newsroom

Header

About CMS
Newsroom
Data & Research

Search CMS.gov

Search Search

Popular terms

Physician Fee Schedule
Local Coverage Determination
Medically Unlikely Edits
Telehealth
Covid-19

CMS.gov main menu

Medicare
Back to main menu
section title h2
- Enrollment & renewal
  Back to menu
  section title h3
  Original Medicare (Part A and B) Eligibility and Enrollment
  
  Annual Medicare Participation Announcement
  
  Providers & suppliers
  
  Medicare Managed Care Eligibility and Enrollment
  
  Part D Eligibility and Enrollment
  
  Health plans
- Coverage
  Back to menu
  section title h3
  Coverage Determination Process
  
  Medicare Coverage Database
  
  Approved facilities, trials, & registries
  
  Telehealth
  
  Medicare Summary Notice
  
  Prescription drug coverage contracting
  
  Coverage with evidence development
  
  Investigational device exemption studies
  
  Prescription drug coverage
  
  Drug coverage claims data
  
  Dental coverage
  
  Preventive Services
  
  Medicare Coverage Center
  
  End Stage Renal Disease (ESRD) Center
  
  Ambulances Services Center
- Regulations & guidance
  Back to menu
  section title h3
  Manuals
  
  Transmittals
  
  CMS Records Schedule
  
  Medicare Fee-for-Service payment regulations
  
  National Provider Identifier Standard (NPI)
  
  Advisory committees
  
  Legislation
  
  Promoting Interoperability Programs
  
  CMS rulemaking
  
  CMS Hearing Officer
  
  Office of the Attorney Advisor (OAA)
  
  Provider Reimbursement Review Board (PRRB)
  
  Medicare Geographic Classification Review Board (MGCRB)
  
  Physician Self-Referral
  
  Quarterly provider updates
  
  E-Prescribing
- Coding & billing
  Back to menu
  section title h3
  Place of service codes
  
  ICD-10 codes
  
  Healthcare Common Procedure Coding System (HCPCS)
  
  Integrated Outpatient Code Editor
  
  National Correct Coding Initiative (NCCI) edits
  
  NCCI for Medicaid
  
  Electronic billing
  
  Medicare Administrative Contractors (MACs)
  
  Provider Customer Service Program
  
  Skilled Nursing Facility (SNF) consolidated billing
  
  Roster billing
  
  Therapy services
  
  Medicare claims & public health emergencies
  
  Guide for Medical Technology Companies and Other Interested Parties
- Payment
  Back to menu
  section title h3
  Medicare Part B Drug Average Sales Price
  
  All Fee-For-Service-Providers
  
  Fee schedules
  
  Prospective Payment Systems
  
  Opioid Treatment Programs (OTP)
  
  Covid-19 Vaccine Toolkit
  
  Bankruptcy
  
  Sustainable Growth Rates & Conversion Factors
  
  Medicare Advantage Rates & Statistics
- Medicare-Medicaid coordination
  Back to menu
  section title h3
  Qualified Medicare beneficiary program
  
  Resources
  
  Qualified Medicare beneficiary program
  
  Spotlight
  
  Events
  
  Financial alignment initiative
  
  Initiative to reduce avoidable hospitalizations
  
  Reports & Guidance
  
  Program of All-Inclusive Care for the Elderly (PACE)
  
  Reporting Fraud
  
  Resources for Medicare-Medicaid plans
  
  Resources for state Medicaid agencies
  
  Healthcare Fraud Prevention Partnership
  
  Clinical Templates
- Appeals & grievances
  Back to menu
  section title h3
  Original Medicare appeals
  
  Managed Care appeals & grievances
  
  Medicare Prescription drug appeals & grievances
  
  Ombudsman Center
  
  Appeals Decision Search (Part C & Part D)
- Quality
  Back to menu
  section title h3
  Value-based programs
  
  Person & Family Engagement
  
  Quality improvement organizations
  
  Nursing home quality improvement
  
  Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP)
  
  Home Health Quality Reporting Program
  
  ESRD Quality Incentive Program
  
  CMS National Quality Strategy
  
  Hospice Quality Reporting Program
  
  Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP)
  
  Appropriate Use Criteria Program
  
  Quality measures
  
  Medicare Advantage quality improvement program
  
  Physician compare initiative
  
  Quality initiatives
  
  Part C and D Performance Data
  
  Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)
- Health & safety standards
  Back to menu
  section title h3
  Quality, Safety & Oversight Group (QSOG)
  
  Quality, safety & oversight general information
  
  Certification & compliance
  
  Emergency preparedness
  
  Clinical Laboratory Improvement Amendments (CLIA)
  
  Accreditation programs
  
  Conditions for coverage & participation
- Employers & plan sponsors
  Back to menu
  section title h3
  Creditable coverage
- IC-Placeholder-1
- Audits & Compliance
  Back to menu
  section title h3
  Part A cost report audit
  
  Part C/Part D compliance & audits
- Forms & notices
  Back to menu
  section title h3
  CMS forms
  
  CMS forms list
  
  Beneficiary Notices Initiative (BNI)
- Health & drug plans
  Back to menu
  section title h3
  Plan payment
  
  Plan payment data
  
  Medical loss ratio
  
  Coverage Gap Discount Program
  
  Managed care marketing
  
  Medicare Advantage application
  
  Medigap (Medicare supplement health insurance)
  
  Medical Savings Account (MSA)
  
  Private Fee-for-Service Plans
  
  Health Care Prepayment Plans (HCPPs)
  
  Cost plans
  
  Special needs plans
  
  Network adequacy
- Coordination of benefits & recovery
  Back to menu
  section title h3
  Overview
  
  Mandatory Insurer Reporting for Group Health Plans (GHP)
  
  Mandatory insurer reporting (NGHP)
  
  Workers' comp Medicare set aside arrangements
  
  Attorney services
  
  Beneficiary services
  
  COBA Trading Partners
  
  Employer services
  
  Insurer services
  
  Prescription drug assistance programs
  
  Provider services
- Settlements
  Back to menu
  section title h3
  Jimmo Settlement
  
  Ryan Settlement
Medicaid/CHIP
Back to main menu
section title h2
- What is Medicaid?
  Back to menu
  section title h3
  Visit Medicaid.gov
  
  View Medicaid maps
  
  Visit CHIP.gov
- Medicare-Medicaid Coordination
  Back to menu
  section title h3
  Integrated care resources
  
  Initiative to reduce avoidable hospitalizations
  
  Financial alignment initiative
  
  Medicaid Integrity Institute
- RG-Placeholder-1
- IC-Placeholder-2
Marketplace & Private Insurance
Back to main menu
section title h2
- About the Marketplace
  Back to menu
  section title h3
  Marketplace oversight
  
  Affordable Care Act
  
  Overview of the exchanges
  
  Exchange coverage maps
  
  Medicare and the Marketplace
- Private Health Insurance
  Back to menu
  section title h3
  Patient’s Bill of Rights
  
  Medical loss ratio
  
  Annual limits
  
  Review of insurance rates
  
  Market rating
  
  Self-funded, non-federal governmental plans
  
  Grandfathered plans
  
  Health Reimbursement Arrangements
  
  Coverage for young adults
  
  Student health plans
  
  Mental health parity and addiction equity
  
  Prevention
  
  Consumer protections & enforcement
  
  Pre-existing condition insurance plan
  
  Qualifying Health Coverage (QHC)
- RG-Placeholder-2
- In-person assisters
  Back to menu
  section title h3
  Information for Partners
  
  Assister outreach & education
  
  Applications, forms, & notices
  
  Assister programs & procedures
  
  Assister technical resources
  
  Assister training & webinars
- Agents & Brokers
  Back to menu
  section title h3
  Resources for Agent & Brokers
  
  Registration & training
  
  Open enrollment
  
  Direct enrollment partners
  
  General resources
  
  Video Learning Center
  
  Agent & Broker FAQ
  
  Marketplace help desk & call centers
  
  Registration Completion List
  
  Marketplace Registration Tracker
  
  AB Suspension & Termination List
  
  Find local help
  
  Issuer and direct enrollment partner directory
  
  Help on demand
  
  SHOP Resources
- Health Plans & Issuers
  Back to menu
  section title h3
  Qualified health plan certification
  
  Summary of benefits & coverage
  
  Insurance programs
  
  Premium stabilization programs
  
  Health insurance market reforms
  
  Minimum essential coverage
  
  Drug pricing & rebate review
- Employers & sponsors
  Back to menu
  section title h3
  Coverage
  
  Regulation & guidance
  
  Small business tax credit & premium assistance
  
  Appeals
  
  Small Business Health Options Program (SHOP)
  
  Early retiree reinsurance program
  
  Employer initiatives
- States
  Back to menu
  section title h3
  Planning & establishing a Marketplace
  
  Territory cooperative agreements
  
  Early innovator program
  
  State flexibility to stabilize the Market
  
  Exchange establishment grants
  
  Pre-existing condition insurance plan
- Resources
  Back to menu
  section title h3
  About Us
  
  Data resources
  
  Letters
  
  Regulations & Guidance
  
  Training resources
  
  Marketplace Coverage Transitions
Initiatives
Back to main menu
section title h2
- Burden Reduction
  Back to menu
  section title h3
  Overview
- Crushing Fraud, Waste, & Abuse
- E-health
  Back to menu
  section title h3
  Overview
- Flu
  Back to menu
  section title h3
  Overview
- Health Equity
  Back to menu
  section title h3
  Coverage to Care
  
  Minority health
  
  Cobertura de atención
  
  Grants & awards
- Healthplan price transparency
  Back to menu
  section title h3
  Overview
- Hospital price transparency
  Back to menu
  section title h3
  Overview
- Innovation Center
  Back to menu
  section title h3
  Overview
  
  About
  
  Key Concepts
  
  Model Data
  
  Value-Based Care Spotlight
  
  Innovation Models
  
  Where Innovation is Happening
  
  Evaluations & Research Reports
- Lookup tools
  Back to menu
  section title h3
  Overview
- Marketplace Open Enrollment
  Back to menu
  section title h3
  Overview
- Maternal Health
  Back to menu
  section title h3
  Overview
- Medicare OE partner resources
  Back to menu
  section title h3
  Overview
- Medicare Open Enrollment
  Back to menu
  section title h3
  Overview
- No Surprise Billing
- Nursing Home Careers
  Back to menu
  section title h3
  Overview
- Open Payments
  Back to menu
  section title h3
  Overview
- Opioids
  Back to menu
  section title h3
  Overview
- Your Patient Rights
  Back to menu
  section title h3
  Emergency Room Rights
  
  Medical bill rights
Training & Education
Back to main menu
section title h2
- CMS National Training Program
  Back to menu
  section title h3
  National Training Program resources
  
  Class modules
- Partner outreach resources
  Back to menu
  section title h3
  Partner with CMS
  
  National Medicare Education Program (NMEP)
  
  Low-Income Subsidy (LIS) outreach
  
  Become a champion for coverage
  
  Faith-Based Partners
  
  Rural Health Partners
  
  American Indian/Alaska Native
  
  Partnering with CMS Center
- Medicare Learning Network® (MLN)
  Back to menu
  section title h3
  Resources & training
  
  Newsletter
  
  Compliance
  
  Partnerships
- CMS Open Door Forums
  Back to menu
  section title h3
  About Open Door Forums
  
  Ambulance
  
  End-Stage Renal Disease (ESRD) Dialysis Facility Care Compare
  
  Home Health, Hospice & Durable Medical Equipment (DME)
  
  Hospital
  
  Long-Term Services & Supports
  
  Physicians, Nurses and Allied Health Professionals
  
  Rural Health
  
  Skilled Nursing Facilities (SNFs)/Long-Term Care
  
  Special Open Door forums
- Look up topics
  Back to menu
  section title h3
  Medicare
  
  Medicaid
  
  CHIP
  
  American Indian/Alaska Native Center
  
  Quality of care
  
  Special populations
  
  Fraud & abuse
  
  States
  
  Privacy
  
  Health conditions & campaigns
  
  New Medicare Card
  
  HIPAA Administrative Simplification
- Learn More
  Back to menu
  section title h3
  Attend events
  
  Find resources
  
  Get training
  
  Find tools to help you help others
  
  Get digital media
- Find your provider type
  Back to menu
  section title h3
  Physicians & other health professionals
  
  Facilities
  
  Health & drug plans
  
  Employers & unions

Back to List of PRRB Jurisdictional Decisions

2018-04

Dynamic List Information

Dynamic List Data

Control Number #

2018-04

Monthly List

Jurisdictional Decisions for April 2018

Downloads

JD 2018-04

Get email updates

Sign up to get the latest information about your choice of CMS topics. You can decide how often to receive updates.

Email

Sign up - opens in a new window

CMS & HHS Websites

Medicare.gov
Medicaid.gov
InsureKidsNow.gov
HealthCare.gov
HHS.gov
HHS.gov/Open

About CMS

About Us
Careers
Newsroom

Tools

Acronyms
Archive
Contacts
Glossary

Helpful Links

Privacy Policy
Plain Language
Privacy Settings
Nondiscrimination & Accessibility
Developer Information
Vulnerability Disclosure Policy

USA Government Sites

Freedom of Information Act
No Fear Act
Inspector General
USA.gov

Connect with CMS

Linkedin link
Youtube link
Facebook link
Twitter link
RSS Feed link

A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services.

7500 Security Boulevard, Baltimore, MD 21244