Aggrieved party

Aggrieved party means a Medicare beneficiary, or the estate of a Medicare beneficiary, who -
(1) Is entitled to benefits under Part A, enrolled under Part B, or both (including an individual enrolled in fee-for-service Medicare, in a Medicare + Choice plan, or in another Medicare managed care plan);
(2) Is in need of coverage for a service that is denied based on an applicable LCD (in the relevant jurisdiction) or an NCD, regardless of whether the service was received; and
(3) Has obtained documentation of the need by the beneficiary's treating physician.

Source

42 CFR § 426.110


Scoping language

For the purposes of this part, the following definitions apply:

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