Standards for Selecting a Data Validation Contractor
CMS requires an independent, external entity to conduct the DV review. Download Appendix A: Standards for Selecting a Data Validation Contractor with the 2025 DV Manual for guidance to acquire a reviewer. You can find Appendix A in the 2025 Parts C and D Data Validation file under the Downloads section of the Part C and Part D Data Validation webpage.
These standards represent the minimum qualifications, credentials, and resources that the selected DVC should possess, including:
Knowledge of the 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
Ability to evaluate an SO's performance of Medicare Part C and Part D data collection, storage, compilation, and reporting using CMS’s data validation standards
Ability to conduct source/programming code review and to interface with a variety of data systems in a secure environment
Experience in conducting DV (for example, HEDIS Compliance Audits™) for commercial entities or governmental agencies
Thorough understanding of Health Insurance Portability and Accountability Act (HIPAA) and Privacy requirements, as well as the Medicare Advantage and Prescription Drug Benefit Programs