Overview of Guidance for Determining Compliance

CMS gives guidance to DVCs on interpreting each of the standards to determine findings. You can find this guidance in both the Medicare Part C and Part D Reporting Requirements Data Validation Procedure Manual (DV Manual) and the EES at the end of the Data Validation Standards.

The guidance offers room for interpretation and isn’t intended to be prescriptive. In these cases, CMS expects the DVC to use their best judgment and justify their findings with supporting documentation, if necessary.

The following pages depict the guidance outlined in the DV Manual for standards 1 through 7. Scroll down to the 2025 Parts C and D Data Validation file under the Downloads section of the Part C and Part D Data Validation webpage to access the DV Manual.

CMS recommends you keep a copy of the DV standards, as found in the EES, with you while reviewing the guidance. Also, the DV Manual includes more information about the guidance.