CMS Part C and D Data Validation Contractor

Centers for Medicare & Medicaid Services (CMS) requires Medicare Part C and Part D organizations to undergo an independent data validation audit to ensure that organizations' reported data are reliable, valid, complete, and comparable. CMS released Standards for Selecting a Data Validation Contractor as guidance for organizations to use in acquiring a data validation contractor.

HealthcareData Company, LLC (HDC) is fully qualified to meet the CMS standards for a CMS Part C and D Data Validation Contractor.

Data validation experience

HDC possesses the necessary specialized experience:

• More than a decade of experience conducting healthcare data systems review and data validation audit projects of similar size and scope
• Knowledge of Medicare Part C and Part D Reporting Requirements and Technical Specifications
• Knowledge of managed care and pharmacy benefits operations and management and how they relate to Medicare Part C and Part D
• Experience with the evaluation of organization data systems for collection and maintenance of data supporting a wide variety of metrics for enrollment, demographics, utilization, providers, quality, compliance, training, testing, oversight, clinical assessment, and pharmacy
• Code review for healthcare quality and utilization measurement for the past fifteen years
• Data validation at the primary source level (e.g., claims, medical records, and other data inputs)
• Operation according to HIPAA privacy and security requirements
• Thorough understanding of industry-standard healthcare data standardization, simplification, and transmission protocols

Staff credentials for CMS Part C and D data validation audits

HDC has qualified and experienced staff including:

• A CPA with experience at national and regional public auditing firms
• Ph.D.s in economics and health care administration
• Certified HEDIS Compliance Auditors (CHCA) with 70+ years combined experience of reviewing managed care information systems, data files, and primary source data
• A 15-year history of conducting Medicare data audits for HEDIS reporting
• Team member with 7 years experience as a senior analyst with a national pharmacy chain.
• Clinical professionals with experience in the interpretation of medical records, claims, and healthcare coding
• Analysts with experience in healthcare compliance review, analytical and statistical studies, disease management, healthcare accreditation, ISO certification, and external quality review.
• Team members experienced in statistical analyses and database management
• Programming code review specialists with 20+ years of experience in healthcare quality and utilization measurement working with a variety of program languages
• Onsite IT staff overseeing data security

Facility requirements necessary for a CMS Part C and D data validation contractor

HDC has all essential physical and operational capabilities.

• HDC has a secure client portal for the exchange of data between the organization and the data validation team. It's fast, easy, and convenient.
• HDC operates in an environment that is fully compliant with HIPAA privacy and data security requirements.
• HDC has a professionally maintained network with storage and back-up capabilities commensurate with industry standards.

HDC is cost effective with resources ready to deploy

HDC is ready to work with your organization as your Part C and D data validation auditor.

• You do not subsidize our start-up costs! HDC's team has invested the up-front time and resources to develop high quality CMS data validation audit tools.
• HDC's exceptional CMS data validation audit tools conserve organization time and staff resources by eliciting required information in an intuitive, efficient manner that eliminates redundancy.
• If preferred by your organization, HDC can append the data validation audit to your organization's HEDIS compliance audit, conserving the time of organization members who may be on both the CMS data validation and HEDIS teams.
• Organizations receiving HEDIS Compliance Auditing services from HDC benefit from CMS data validation auditors already familiar with key healthcare information systems, including claims, enrollment, provider network, pharmacy.
• Organizations already contracting with HDC for HEDIS auditing will be in a position to minimize the number of vendors.
• HDC maintains a fully-staffed corporate office year-round and can start the process on your timeline.
• HDC operates in a deadline-focused environment to ensure completion of the process on time.

Contact HDC for your Part C and D data validation auditing requirements

To learn more and get started, please call Paul Ackroyd at (717) 458-0554 or email him at pjackroyd@hdcdata.com.

Few auditor firms are able to provide the necessary level of expertise directly from their corporate office, with year-round support!