← Glossary · CMS & regulatory
Audit elements
The three areas CMS tests in ODAG: timeliness, processing of coverage requests, and classification of requests.
Timeliness is tested at the universe level against the required decision, notification, forwarding and effectuation deadlines. Processing of coverage requests reviews sampled cases for proper notice, qualified reviewers, clinical accuracy, extensions and downgrades. Classification of requests checks whether dismissed requests and grievances were classified correctly.
Sources: ODAG protocol, Audit Elements Tested, PDF p. 3; CPE protocol, Audit Elements Tested, p. 3; compliance standards 1.1-1.7, pp. 5-11.