Effectuation
Carrying out an approved or overturned decision in the plan's system: authorizing, providing or paying for the service.
Effectuation is when the plan acts on a decision in the enrollee's favor, for example authorizing or providing the service or Part B drug, or paying the claim. Table 2 records the date (and time for expedited) a reconsidered determination was effectuated, and Table 4 tracks effectuation of decisions overturned by the IRE, ALJ or MAC. Supporting documentation includes approval in the OD/reconsideration systems and evidence in the claims adjudication system.
Sources: ODAG protocol, Timeliness 1.11-1.17, PDF pp. 8-9; Supporting Documentation Submissions, PDF p. 47; CDAG protocol, Universe Table 1, Columns W-X, p. 20; Universe Table 5, Column M, p. 51.