Part C and Part D Data Validation
Guidance for organizations contracted to offer Medicare Part C and Part D benefits regarding CMS reporting standards and data validation specifications with respect to the Part C and Part D reporting requirements. These standards and specifications provide a review process for Medicare Advantage Organizations (MAOs), Cost Plans, and Part D sponsors to use to conduct data validation checks on their reported Part C and Part D data.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: May 06, 2020
This section contains information related to the validation of the Part C and Part D reporting requirements data reported to CMS by Medicare Advantage organizations and Part D sponsors. Sponsoring organizations must participate in an annual retrospective data validation of the Part C and Part D Reporting Requirements data and select a data validation contractor to conduct the audit independently per CMS’ specifications. The data validation is retrospective because it occurs in the year subsequent to the contract year (CY). For example, the data validation for CY 2022 data was conducted in 2023. To ensure the independence of the data validation, sponsoring organizations will not use their own staff and will be responsible for acquiring external data validation resources.
CMS publishes contract-level Limited Data Set (LDS) files of Part C and Part D reporting requirements data on an annual basis on the CMS LDS webpage, following the data validation process and other CMS reviews. CMS cannot guarantee that the release of these data will meet any timeframe. To request access to these LDS files, researchers must agree to certain data privacy/security requirements and data use policies by signing a Data Use Agreement (DUA) with CMS and paying the associated data processing fees. Reporting requirements and technical specifications may change from year to year. Part C and Part D reporting requirements and technical specifications can be found on the Related Links below.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.