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 D reporting section. The DVC should follow the same guidance given for Part C reporting sections on the previous page.
| Part D Reporting Sections | Example Source Data |
|---|---|
| Medication Therapy Management (MTM) Programs | Claims Files (to confirm changes to drug therapy) Evidence of communication (for example, prescriber letters to confirm medication reviews, prescriber interventions, and changes to drug therapy) Member Files (to confirm LTC residency) MTM Program files (if separate from Member Files) to confirm targeting criteria, enrollment, opt out dates, reasons |
| Grievances | Customer Service Call Logs Member Letters Case Notes |
| Coverage Determinations/Redeterminations | Adjudicated Claims Customer Service Call Logs Member/Provider/Authorized Representative Requests Case Notes |
| Improving Drug Utilization Review Controls | Rejected Claims Adjudicated Claims Case Notes/Member files Customer Service Call Logs Member/Provider/Authorized Representative Requests |