Data Extraction Process Detail
Requirement for Extraction & Review of Source Data
The following table offers guidance on examples of source data needed for each Part C reporting section. Since the list isn’t comprehensive, other source data could exist. CMS requires the DVC to make sure that all samples represent the underlying population (full census data set).
| Part C Reporting Sections | Example Source Data |
|---|---|
| Grievances | Customer Service Call Logs Member Letters Case Notes |
| Organization Determinations/Reconsiderations | Adjudicated Claims Customer Service Call Logs Member/Provider/Authorized Representative Requests |
| SNPs Care Management | Enrollment Files A and B Electronic or paper copies of the completed health risk assessment (HRA) tool, evidence of communication (fax, email, letter) with providers for verification of care (reports from specialists, copies of medical records, copies of medical histories), the Outcome and Assessment Information Set (OASIS) assessment tool for beneficiaries receiving home care, or the Minimum Data Set (MDS) assessment tool for beneficiaries in LTC facilities |