Part C and Part D Data Validation

This section contains information related to the Centers for Medicare & Medicaid Services' (CMS) data validation of the Part C and Part D reporting requirements. Organizations contracted to offer Medicare Part C and Part D benefits are required to report data to CMS on a variety of measures. CMS has developed reporting standards and data validation specifications with respect to the Part C and Part D reporting requirements. These standards and specifications provide a review process for Medicare Advantage Organizations (MAOs), Cost Plans, and Part D sponsors to use to conduct data validation checks on their reported Part C and Part D data. The data validation is “retrospective,” referring to the fact that it normally occurs in the year subsequent to the measurement year.   For example, the data validation for CY 2012 data was conducted in CY 2013.   In order to ensure the independence of the data validation, organizations will not use their own staff to conduct the data validation. Instead, MAOs, Cost Plans, and Part D sponsors will be responsible for acquiring external data validation resources.

CMS posts public use files of plan-reported data on an annual basis, following the data validation process and other CMS reviews. CMS cannot guarantee the release of these data to meet any timeframe. Most of these data have undergone the data validation process and are used by CMS for operational purposes. Users should carefully review the Technical Specifications, including information included in the CMS Disclaimer and User Agreement about data integrity, and privacy protection. Data reporting requirements and technical specifications may change from year to year. Therefore, users must familiarize themselves with any modifications to the reporting requirements or technical specifications when considering these data across plan years.  Part C and D reporting requirements and technical specifications can be found on the Related Links below. Click the selection that best matches your information needs.