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Coverage determination
A sponsor's decision on an enrollee's request for Part D drug coverage. Standard ones are due in 72 hours, expedited ones in 24 hours.
The protocol audits coverage determinations of several types, such as prior authorization, step therapy authorization, tiering exception, formulary exception and reimbursement request. A standard coverage determination must be notified no later than 72 hours after receipt, and an expedited one no later than 24 hours after receipt.
Source: CDAG protocol, Timeliness 1.1-1.2, p. 5; Processing of Coverage Requests 2.1, p. 9.