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Universe Table 3: Payment Organization Determinations and Reconsiderations (PYMT_C)
The ODAG universe listing payment decisions and payment appeals on claims from non-contract providers, enrollees and pharmacies.
Table 3 lists all payment organization determinations and payment reconsiderations the sponsoring organization approved, denied or dismissed from non-contract providers, enrollees and non-contract pharmacies. Column L records whether each request was processed as an OD or a Recon. Duplicate claims, payment adjustments, reopenings, withdrawals and retrospective reviews are excluded.
Source: ODAG protocol, Universe Table 3 record layout guidance, PDF p. 29.