SO Appeal of Data Validation Determination

If the SO disagrees with any of the findings submitted by the DVC, it may submit information indicating this appeal to CMS within 5 business days following the June 15 data validation deadline. Submissions should be sent to CMS via the [email protected] resource mailbox and should contain all the following information to be considered for review:

An SO has the right to appeal:

• Reporting section score of less than 95%
• Non-compliant data validation standards/sub-standards such as, a “No” or a 1, 2, or 3 on the 5-point Likert scale in the specific data element’s data validation

If the SO wishes to appeal, it should submit an appeal to CMS 5 business days following the DV deadline. Submissions should be sent to CMS via the [email protected] resource mailbox and should contain all the following information to be considered:

• Email subject line should state: “Data Validation: Appeal”
• Content of email should include the information below, in list format and in the following order:
  • Name of SO
  • CMS contract numbers
  • SO’s contact name, title, phone number and email address
  • Name of DVC organization
• · For each appeal, list the following information:
  • Justification for the appeal
  • Include as attachment any documentation supporting the justification for appeal. The documentation should have been in existence at the time of the DV. For example, if after the DV, the SO resubmits corrected data, revises a policy and procedure, or corrects a programming code that caused it to improperly calculate reported data; the SO can’t submit documentation of these corrections to appeal.

Once CMS gets the appeal, CMS will carefully consider the justification and any supporting documentation to determine if any changes should be made. CMS hasn’t set a time frame for the consideration of SO appeals.

Refer to Section 6.2.3. of the DV Manual for more information on SO Appeal of DV Determination.