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Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(g))
 
No Modified
 
Mandatory
 
42 CFR 422.516(a)(3),(a)(4),(a)(6) 42 CFR 423.514 (a)(3) (a) (4) (a) (6) 42 CFR 423.514 (a)(1) (a) (2) 42 CFR 422.516_(a)(1),(a)(2)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CY 2023 DV Appendix B_20221014_508.pdf Yes No Printable Only
Instruction CY 2023 DV_DV Procedure Manual_20221014.pdf Yes No Fillable Printable
Form and Instruction CMS-10305 Organizational Assessment Instrument CY 2023 DV_Appendix E_20221014_508.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10305 Grievances (Part C)_2022 CY 2023 DV Appendix J_C-Grievances_20221014_508.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10305 Grievances (Part D) _2022 CY 2023 DV Appendix J_D-Grievances_20221014_508.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10305 Coverage Determinations and Redeterminations (Part D) 2022 CY 2023 DV Appendix J_CDR_20221014_508.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10305 Improving Drug Utilization Review Controls (Part D) 2022 CY 2023 DV Appendix J_DUR_20221014_508.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10305 Medication Therapy Management (MTM) Programs (Part D) 2022 CY 2023 DV Appendix J_MTM_20221014_508.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10305 Organization Determinations/Reconsiderations (Part C) 2022 CY 2023 DV Appendix J_ODR_20221014_508.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10305 Special Needs Plans (SNPs) Care Management 2022 CY 2023 DV Appendix J_SNP_20221014_508.pdf Yes Yes Fillable Printable

Health Health Care Services

 

793 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 793 0 0 32 0 761
Annual IC Time Burden (Hours) 21,535 0 0 589 0 20,946
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Appendix B Crosswalk CY2022 to CY2023 DV Appendix B Crosswalk of Changes_Draft_20220714.pdf 08/04/2022
Appendix J Crosswalk CY2022 to CY2023 DV Appendix J Crosswalk of Changes_Draft_20220714.pdf 08/04/2022
Appendix E: Crosswalk Crosswalk of Changes from CY2022 to CY2023_App E_Draft_20220310_508.pdf 08/04/2022
Appendix B DV Crosswalk_Post 30-Day CY2022 to CY2023 Appendix B DV Crosswalk_Post 30-Day PRA_20221014_508.pdf 10/25/2022
Appendix J DV Crosswalk_Post 30-Day CY2022 to CY2023 Appendix J DV Crosswalk_Post 30-Day PRA_20221014_508.pdf 10/25/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.