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Medicare Parts C and D Universal Audit Guide

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The Medicare Part C and Part D Universal Audit Guide merge the two previously used Part C and Part D
audit guides. As a result of this combined effort, the Universal Audit Guide now reflects uniform
language, omits all elements that were previously deleted, and no longer has duplications. Additional
details on these specific changes are highlighted below. These changes reflect updates made as a result
to the 60 day posting that began July 31, 2009.

Chapter 1
Removed ER02, ER03, ER06, ER08, ER14, ER15, ER802, ER803, DN01, DN04, and DN07 from the Part D
guide because they were duplicative in the Part C guide.
Removed element ER20 as it was a duplicative of ER05.
Added elements ER25, ER26 and DN17 to provide plans with additional requested information.
Revised element ER14 to provide plans with additional requested information.
Chapter 2
Separated Late Enrollment Penalty elements from the Part D Enrollment and Disenrollment chapter and
created its own chapter.
Chapter 3
Combined Part D chapter Provider Communication with Part C chapter Provider Relations.
Added elements PR08, PR09, PR10, PR11, PR12, PR13 to provide plans with additional requested
information.
Chapter 4
Removed MR01, MR05, MR07, MR08, and MR11 from the Part D guide because they were duplicative in
the Part C guide.
Added elements MR21, MR22, MR23, MR24, MR25, MR26 and MR27 to provide plans with additional
requested information.
Chapter 5
Added elements AA06, AA07, AA08 and CS01 to provide plans with additional requested information.
Chapter 6
Combined Part D Quality Assurance with the Part C chapter Quality Assurance. Moved elements QA01,
QA02, QA03, QA04, and QA05 from Part D chapter Drug Utilization Management, Quality Assurance,
and Electronic Prescribing and inserted into this chapter.
Added elements QY08 through QY10 to provide plans with additional requested information.
Chapter 7
Combined Chapter 16: First-Tier and Downstream Contracts/Maintenance of Records and Chapter 7:
Contracts. Chapter 7: Contracts title remained unchanged.
Removed element CN08 as it was duplicative of CP01.
Renamed Chapter 16 elements from CN01, CN02, CN03, CN04, CN05 and CN06 to Chapter 7 elements
CN09, CN10, CN11, CN12, CN13, and CN14.
Added elements CN15 and CN16 to provide plans with additional requested information.
Chapter 8
Removed GV01 and GV04 from the Part D guide because they were duplicative in the Part C guide.
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Chapter 9
Moved element CFO1 from Part C chapter Beneficiary and Beneficiary Protections and inserted into this
chapter.
Renamed element from PR02: Use of SSN/HICN to element CF01 to eliminate duplication in element
numbers as Chapter 3: Provider Communication and Relations also had an element PR02.
Renamed prior element CF01 to CF02.
Chapter 19
Removed element PP01 from Chapter 19 (thus eliminating Chapter 19) to eliminate duplication as this
element is listed in Chapter 15: Compliance Plan element CP01.
Chapter 20
Combined Part D chapter Employer Group Health Plan Premiums with Part C chapter Employer Group
Health Plan Premiums. Removed SU801 from the Part D guide because it was duplicative in the Part C
guide.

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File Typeapplication/pdf
AuthorLaura A. Dash
File Modified2009-10-19
File Created2009-10-19

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