Reconsideration

A reconsideration is the sponsoring organization's review of an organization determination. If the plan overturns its decision it notifies the enrollee and effectuates; if it upholds the decision it forwards the case to the IRE. Pre-service reconsiderations are reported in Table 2 and payment reconsiderations in Table 3 (entered as Recon in Column L).

Source: ODAG protocol, Timeliness 1.5-1.8, PDF pp. 6-7; Universe Table 3, Column L, PDF p. 31.