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Effectuations of Overturned Decisions universe (EFF_D)
CDAG Universe Table 5: sponsor decisions fully or partially overturned by the IRE, ALJ or MAC that required the sponsor to effectuate them.
Table 5 lists coverage determinations, redeterminations or at-risk determinations overturned by the IRE, ALJ or MAC that require effectuation as pre-benefit, post-service (payment) or an at-risk determination. The date the sponsor received the overturn decision (Column J) must fall within the period. Cases re-opened by the sponsor, or dismissed or upheld by the review entity, are excluded.
Source: CDAG protocol, Universe Table 5: Part D Effectuations of Overturned Decisions by IRE, ALJ or MAC (EFF_D) Record Layout, pp. 49-52.