Medicare Data Validation Audit Resources
Part C and Part D Data Reporting Requirements
Medicare Part C Plan Reporting Requirements Technical Specifications Document, Version Date: February 24, 2010
http://www.cms.gov/PrescriptionDrugCovContra/Downloads/ MemoPartCTechSpecs_02.25.10.pdf
Medicare Part D Plan Reporting Requirements: Technical Specifications Document Contract Year 2010, Effective Date: January 1, 2010
http://www.cms.gov/PrescriptionDrugCovContra/Downloads/ PartDReportingRqmtsTechSpecs_2010.pdf
Medicare Part D Reporting Requirements: Effective as of January 1, 2010
http://www.cms.gov/PrescriptionDrugCovContra/Downloads/ PartDReportingRequirements_2010.pdf
2010 Call letter, Medicare Advantage Organizations, Medicare Advantage-Prescription Drug Organizations, Cost-Based Contractors, Prescription Drug Plan Sponsors, Employer/Union-Sponsored Group Health Plans, Programs of All-Inclusive Care for the Elderly Organizations, March 30, 2009, pages 27-28
http://www3.cms.gov/PrescriptionDrugCovContra/Downloads/ 2010CallLetter.pdf
CMS Memorandum 12/15/2008: Parts C & D Reporting Requirements Data Analysis Project
http://www.cms.gov/PrescriptionDrugCovContra/Downloads/ MemoMonitoringCD_12.15.08.pdf
Part C and Part D Data Validation
CMS memorandum 12/23/2009: Implementation Changes in the Medicare Part C and Part D Reporting Requirements and Data Validation
http://www.cms.gov/PrescriptionDrugCovContra/Downloads/ HPMS%20DV%20STD.pdf
CMS memorandum 11/23/2009: Medicare Part C and Part D Reporting Requirements and Data Validation; Q&As Parts C & D Data Validation Standards and Procedures
http://www.cms.gov/PrescriptionDrugCovContra/Downloads/ MemoDVAQandA_11.23.09.pdf
CMS memorandum 9/16/2009: Call for industry comments on the Medicare Part C and Part D Data Validation Standards, Standards for Selecting a Data Validation Contractor, and Organizational Assessment Instrument
http://www.cms.gov/PrescriptionDrugCovContra/Downloads/ MemoDataValComment_09.16.09.pdf
Part C and Part D General Requirements
Medicare Managed Care Manual
http://www.cms.hhs.gov/Manuals/IOM/itemdetail.asp?filterType=none &filterByDID=-99&sortByDID=1&sortOrder=ascending&itemID=CMS019326
Medicare Prescription Drug Benefit Manual
http://www.cms.gov/PrescriptionDrugCovContra/12_PartDManuals.asp
CY 2010 Medicare Advantage and Prescription Drug Readiness Assessment Request and Checklist
http://www.cms.gov/PrescriptionDrugCovContra/Downloads/ MemoCY10Readiness%20Assessment_12.01.09.pdf
http://www.cms.gov/PrescriptionDrugCovContra/Downloads/ MemoCY2010ReadinessChecklist_09.15.09.pdf
Additional CMS Links
For measure-specific and technical guidance, visit CMS's Health Plan Management System (HPMS) Web site:
http://www.cms.gov/PrescriptionDrugCovContra/HPMSGH/list.asp#TopOfPage
http://www.cms.gov/PrescriptionDrugCovContra/HPMSSD/list.asp#TopOfPage
and the Plan Reporting and Oversight Page
http://www.cms.gov/PrescriptionDrugCovContra/ 08_RxContracting_ReportingOversight.asp#TopOfPage
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