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2025 Medicare Part C & Part D Reporting Requirements & Data Validation

Lesson 1 Summary

  • DV standards are the same for Part C and Part D reporting
  • Check that source documents correctly capture required data
  • SOs need to secure documents and allow DVCs to access them
  • Documentation must be clear and easy to understand
  • Data fields should have clear and consistent labels
  • Source documents should be error-free
  • Use version control for documents
  • Report data for the period of January 1 to December 31
  • Assign data at the correct level, such as the plan or contract level
  • Maintain good communication, ask for documents early, and train staff for data validation tasks

DVCs should:

  • Compare the contract numbers specified for the SO in the PRDVM with those in the DV cycle and make sure that the PRDVM will accept data for all active contract numbers
  • Act as a conduit to get clarification from CMS and make sure regular status meeting updates and prompt responses to plan requests occur
  • Make sure auditors are cross-trained on relevant reporting sections