Administrative Law Judge (ALJ)
The purpose of the Administrative Law Judge (ALJ) website is to educate all staff members as to how and why we make the decisions at the contractor level, and what resources we use to do so. The following groupings are used when making decisions on appeals at the contractor level.
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The sites contained in this grouping are references that come directly from the United States Government or their agencies. They are the top-level regulations that Noridian follows when making contractor decisions. Read more... |
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The sites contained in this grouping are the coverage determinations that determine Medicare coverage at the National level or the Carrier level. Per CFR § 405.1060, an National Coverage Determination (NCD) is binding on fiscal intermediaries, carriers, Quality Improvement Organization (QIO), Qualified Independent Contractors (QICs), ALJs, and the Medicare Administrative Contractor (MAC). Per § 405.1062, ALJs are not bound by Local Coverage Determination (LCDs), but will give substantial deference to these policies if they are applicable to a particular case. Read more... |
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The sites contained in this grouping are referential. They are helpful when trying to find out information about particular claims or services. A briefing as to what can be found on the rest of Noridian's website can also be found here. Read more... |
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