Appendix 1: Data Validation Standards |
2010 (old version) |
2013 (new version) |
Type of Change |
Reason for Change |
Burden Change |
The following reporting sections underwent data validation in Part C: Benefit Utilization, Procedure Frequency, Serious Reportable Adverse Events (SRAEs), Provider Network Adequacy, Grievances, Organization Determinations/Reconsiderations, Employer Group Plan Sponsors, Plan Oversight of Agents, and Special Needs Plan Care Managment (SNPs). The following reporting sections underwent data validation in Part D: Retail, Home Infusion, and Long Term Care Pharmacy Access, Medication Therapy Management Programs (MTM), Grievances, Coverage Determinations and Exceptions, Appeals, Long-Term Care Utilization, Employer/Union Sponsored Group Health Plan Sponsors, and Plan Oversight of Agents. Therefore, a total of 9 reporting sections in Part C underwent the data validation and 8 reporting sections in Part D underwent the data validation. |
For 2013, the following Part C reporting sections will undergo data validation: SRAEs-2012 and 2013, Grievances, Organization Determinations/Reconsiderations, SNPs-2012 and 2013. The following Part D reporting sections will undergo data validation: MTM, Grievances, Coverage Determinations and Exceptions, Redeterminations, and Long-Term Care Utilization. That is a total of 6 Part C reporting sections and 4 Part D reporting sections. |
Rev |
Reporting for a number of reporting sections was suspended between 2011 and 2014. This was due to the information being available elsewhere or a decision not to data validate if the reporting section was used for monitoring only. |
Reduction |
The number of data elements for Part C grievances was 7. The number of data elements for Part D grievances was 10. |
The number of data elements for Part C grievances was 18, the same as Part D. |
Rev |
Users were of the opinion that more data elements were needed to adequately categrize types of grievances. |
Increase. This was due to more standards being validated due to an increase in data elements. |
The number of data elements for Coverage and Exceptions was 10. |
The number of data elements is 28. |
Rev. |
Increase in data elements was needed to get better use out of this reporting section. |
Increase. This was due to more standards being validated due to an increase in data elements. |
Reporting section was called "Appeals". |
"Appeals" was changed to "Redeterminations". |
Rev. |
This new term is more consistent with current usage. |
None |
Appeals had 3 data elements. |
The number of data elements in Appeals increased from 3 to 12. |
Rev. |
Increase in data elements was needed to get better use out of this reporting section. |
Increase. This was due to more standards being validated due to an increase in data elements. |
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Appendix 5: Findings Data Collection Form |
2010 (old version) |
2013 (new version) |
Type of Change |
Reason for Change |
Burden Change |
"MSC" refers to "measure Specific Criteria." |
"MSC" is replaced by "RSC" to refer to "Reporting Section Specific Criteria." |
Rev. |
To be consistent with term change that was adopted: "Measure" was replaced by "Reporting Section." |
None |
The following reporting sections underwent data validation in Part C: Benefit Utilization, Procedure Frequency, Serious Reportable Adverse Events (SRAEs), Provider Network Adequacy, Grievances, Organization Determinations/Reconsiderations, Employer Group Plan Sponsors, Plan Oversight of Agents, and Special Needs Plan Care Management (SNPs). The following reporting sections underwent data validation in Part D: Retail, Home Infusion, and Long Term Care Pharmacy Access, Medication Therapy Management Programs (MTM), Grievances, Coverage Determinations and Exceptions, Appeals, Long-Term Care Utilization, Employer/Union Sponsored Group Health Plan Sponsors, and Plan Oversight of Agents. Therefore, a total of 9 reporting sections in Part C underwent the data validation and 8 reporting sections in Part D underwent the data validation. |
For 2013, the following Part C reporting sections will undergo data validation: SRAEs-2012 and 2013, Grievances, Organization Determinations/Reconsiderations, SNPs-2012 and 2013. The following Part D reporting sections will undergo data validation: MTM, Grievances, Coverage Determinations and Exceptions, Redeterminations, and Long-Term Care Utilization. That is a total of 6 Part C reporting sections and 4 Part D reporting sections. |
Rev |
Reporting for a number of reporting sections was suspended between 2011 and 2014. This was due to the information being available elsewhere or a decision not to data validate if the reporting section was used for monitoring only. |
Reduction |
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