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Rejected Claims Formulary Administration (RCFA) universe
FA Universe Table 1: every rejected Part D claim with a date of service in a 2-, 4- or 8-week review period, depending on enrollment.
Table 1 lists all rejected claims with dates of service in the period before and including the audit engagement letter date: 8 weeks for sponsors with fewer than 20,000 enrollees, 4 weeks for 20,000 to under 500,000, and 2 weeks for 500,000 or more. It shares one record layout with Table 2 (RCT) and must include enrollees in employer plans and Medicare-Medicaid Plans. Data must not be filtered. CMS samples it for universe integrity testing and for the Formulary Administration element.
Source: FA protocol, Universe Requests and scope table, PDF pp. 8-10; Universe Table 1 record layout, PDF pp. 10-13.