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

Lesson 2 Summary

  • The second phase of DV focuses on performing DV activities after planning
  • The SO must complete the OAI (Appendix E) to document systems and processes for data collection and reporting
  • SOs should submit the OAI and related documents to the DVC electronically, ensuring HIPAA compliance
  • DVCs review the OAI for completeness, look for gaps, and prepare for site visits
  • Site visits include interviews, observing reporting processes, and getting census or sample files for validation
  • Data validation involves extracting full census data, which is preferred, or random samples
  • Random samples aren’t suitable for total counts or sums; a full census is needed
  • File naming conventions and data dictionaries should be consistent for all data transfers

  • The SO and the DVC should work together to coordinate the delivery of the OAI and documentation so that they thoroughly review it before the on-site or virtual visit.
  • The SO should properly document programming code with descriptive comments that allow the DVC to understand the purpose of each program section.
  • The SO should set up standard naming conventions for documentation and supporting documentation.
  • The SO should perform QA checks on data against the full census.
  • The DVC should request that sponsors supply source documentation, interim, and final data as early as possible, and start recalculations at the start of the DV review cycle. The DVC should maintain a central data and documentation repository with adequate storage capacity and consistent file-naming conventions.
  • DVCs and PBMs should set up data extraction expectations early in the DV process to allow PBMs enough time to pull data according to the DVC’s requirements.
  • The DVC should create a sign-in sheet to complete throughout the on-site or virtual visit to collect contact information for each SO’s report owners and subject matter experts in case they need any follow-up.
  • The DVC should set up a Point of Contact (POC) to coordinate different sections of the audit for efficient communication.