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Part D Coverage Determinations, Appeals, and Grievances (CDAG)
The CMS program audit area that tests how a sponsor handles Part D drug coverage requests, appeals, grievances and at-risk determinations.
CDAG is the program area this protocol covers. CMS evaluates sponsoring organizations on four audit elements: Timeliness, Processing of Coverage Requests, Classification of Requests, and Administration of Drug Management Program. The audit relies on seven universe tables (CD, CDER, PYMT_D, RD, EFF_D, GRV_D and AR).
Source: CDAG protocol, Program Audit Protocol, Purpose and Audit Elements Tested, p. 3.