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Organization determination
The plan's initial decision on a request for coverage of a service, item, Part B drug or payment.
An organization determination is the sponsoring organization's initial coverage decision, recorded as Approved, Denied or Dismissed. Pre-service ODs are reported in Table 1 and payment ODs (claims) in Table 3. Standard pre-service ODs must be notified within 14 calendar days (28 with an extension), and expedited ones within 72 hours (17 calendar days with an extension).
Source: ODAG protocol, Timeliness 1.1-1.4, PDF p. 5; Universe Table 1 guidance, PDF p. 17.