Example of the Part C Grievances Reporting Section from the EES
Grievances (Part C) 2024
Organization Name:
Contract Number:
Reporting Section: Grievances
Last Updated:
Date of Site Visit (on-site or virtual):
Name of Reviewer:
Name of Peer Reviewer:
Contract Number:
Reporting Section: Grievances
Last Updated:
Date of Site Visit (on-site or virtual):
Name of Reviewer:
Name of Peer Reviewer:
Instructions:
- In the "Data Sources and Review Results:" column, enter the review results and/or data sources used.
- Enter "Y" if the requirements have been met. If any requirement has not been met, enter "N". For Standards 6 and 7, if these standards do not apply, enter "N/A".
- Enter 'Findings' as follows based on the 5-point scale: Select "1" if plan data has more than 20% error, select "2" if plan data has between 15.1% - 20.0% error, select "3" if plan data has between 10.1% - 15.0% error, select "4" if plan data has between 5.1% - 10.0% error, select "5" if plan data has less than or equal to a 5% error.
| Standard/Sub-standard ID | Standard/Sub-standard Description | Data Elements | Data Sources and Review Results: Enter review results and/or data sources | Enter 'Findings' using the applicable choice in the appropriate cells. Cells marked with an '*' should not be edited. |
|---|---|---|---|---|
| 1 | Database management and structure: A review of source documents (for example, programming code, spreadsheet formulas, analysis plans, saved data queries, file layouts, process flows) shows that all source documents accurately capture required data fields and the SO has properly documented them. | Data Sources: | * | |
| 1.a | SOs properly secured source documents and output, and have referenced data file locations correctly so that DVCs can retrieve source documents at any time to validate the information submitted to CMS via CMS systems. | Review Results: |