MEDICARE ADVANTAGE DATA VALIDATION SERVICES

When is comes to Medicare Advantage Data Validation, HealthSpective’s principals have successfully performed over 100 of these projects over several years since the inception of this CMS Program in 2010 . Our team has the knowledge and experience to help your organization with this regulatory requirement in an economic and efficient manner.

 

Background:

The Centers for Medicare & Medicaid Services (CMS) requires that Health Plans contracted to offer Medicare Part C and/or Part D benefits be subject to an independent yearly review to validate data reported to CMS per the Medicare Part C and Part D Reporting Requirement Technical Specifications (Technical Specifications). The purpose of the independent data validation (DV) is to ensure that Part C and Part D health plans are reporting health and drug plan data that are reliable, valid, complete, comparable, and timely.

The validated data improves reporting and provides CMS with assurance that data are credible and consistently collected and reported by Part C and Part D health plans. CMS uses these reported data to respond to inquiries from Congress, oversight agencies, and the public about an health plan’s performance using indicators such as operations, costs, availability and use of services, provider network adequacy, and grievance rates. The validated data also allow CMS to more effectively monitor and compare the performance of health plans over time. These data may be used for Star Ratings, and other performance measures. Additionally, health plans can take advantage of the DV process to more effectively assess their own performance and make improvements to their internal data, systems, and reporting processes.

The primary purpose of this Procedure Manual (Manual) is to provide health plans and the data validation contractors (DVCs) they select to perform the DV with information regarding the Part C and Part D Reporting Requirements Data Validation program. The Manual provides background information and an overview of the DV program, discusses the scope and timeframe required for the DV, and describes the tools and processes used for conducting the DV.