Pass/Not Pass Determination Overview

Let's start with an overview of CMS Pass/Not Pass determinations. The Yes/No or 5-point Likert score findings for each of the DV standards, sub-standards, and data elements relate to CMS-assigned percentage points. Appendix J: Data Validation Pass/Not Pass Determination Methodology of the DV Manual identifies the individual score CMS assigns to each standard and sub-standard for all confirmed reporting sections.

Upon final submission of findings, DVCs generate a percentage score in the Health Plan Management System (HPMS) for an SO.

CMS has set 95% as the passing DV threshold for each reporting section, as well as for Part C, Part D, and combined scores. SOs may view their individual contracts’ validation results in HPMS. CMS will send follow-up communication to contracts scoring below 95% on the overall Part C, Part D, or combined score.

Remember, you can download Appendix J on the Part C and Part D Data Validation webpage under the Downloads section.

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