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pdfChanged title of document to Medicare Part C
Reporting Requirements
Burden
Change
Reason for
Change
Type of
Change
2019 (new
version)
2018 (old
version)
Medicare Part C Technical Specification
Document
Update
Title is more accurate since the technical
No change
specifications for Part C Reporting will be put in a
separate document to enable CMS to update based
on real time feedback from MA Plans through the
Part C mailbox.
References to Benefit Utilization, Procedure
Deleted
Frequency, Serious Reportable Adverse Events,
and Provider Adequacy
Update
Reporting sections suspended in previous years.
No change
Grievance Category - Enrollment/Disenrollment Deleted
New
Data collection is no longer necessary for
monitoring purposes.
Decrease
Grievance Category - Plan Benefit Grievances
Deleted
New
Data collection is no longer necessary for
monitoring purposes.
Decrease
Grievance Category - Access Grievances
Deleted
New
Data collection is no longer necessary for
monitoring purposes.
Decrease
Grievance - Category - Marketing Grievances
Deleted
New
Data collection is no longer necessary for
monitoring purposes.
Decrease
Grievance Category - Customer Service
Grievances
Deleted
New
Data collection is no longer necessary for
monitoring purposes.
Decrease
Grievances Category - Organization
/Retermination/ Reconsideration Process
Grievances
Deleted
New
Data collection is no longer necessary for
monitoring purposes.
Decrease
Grievance Category -Quality of Care
Deleted
New
Data collection is no longer necessary for
monitoring purposes.
Decrease
Grievance Category - Grievances Related to
"CMS Issues"
Deleted
New
Data collection is no longer necessary for
monitoring purposes.
Decrease
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
Grievance Category - Other Grievances
Deleted
New
Data collection is no longer necessary for
monitoring purposes.
Decrease
Organization Determination /Reconsideration
Reporting Section
Data Elements Changed from Numbers to Letters
Update
To be consistent with Part D Reporting
None
New
Elimination of timeliness requirement for O/D totals Decrease
to be consistent with Part D Reporting
Organization Determination (O/D) Totals - Data Deleted
Element 6.2
N/A
Reporting O/D Totals Initiated by
New
Enrollee/Representative and Provider for all Claims
and Services under Subsection #1, Data Elements
D-G
To learn more information about who is submitting Increase
the request for O/D.
O/D - Data Elements 6.3 - 6.9 - Totals for all
Services and Claims resulting in a fully
favorable, partially favorable or adverse
disposition.
O/D --Subsection #2, Data Elements A-L,
Dispostion - All O/D - Totals for all services and
claims resulting in a fully favorable, partially
favorable or adverse disposition are reported by
contract and non-contract providers.
New
To learn more information about whether the
service or claim is being provided by a contract or
non-contract provider.
Increase
ODR - Reconsiderations - Data Elements 6.12- ODR - Reconsiderations. Totals for all
New
6.18 - Totals for Reconsiderations for claims
reconsideration for claims and services now
and services
categorized by Enrollee/Representative or Provider
under subsection #3 Data Elements D-G.
To learn more information about who is submitting
the request for Reconsiderations.
Increase
Mid-Year Network Changes
Suspended
New
Data that has not been used and will enable CMS
agency focus on other reporting sections.
Decrease
Private Fee For Service Provider Payment
Dispute Resolution Process
Suspended
New
Most of the Issues related to this reporting section
have been addresssed, and number of plans
participating in this reporting sections have
diminished signifcantly.
Decrease
MMPs
MMPs will no longer required to report data specfic Update
to ODR and Grievances under Part C reporting.
Streamline existing reporting requirements for
MMPs.
No change
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
| File Type | application/pdf |
| File Title | Crosswalk of Changes for Part C Reporting Requirements |
| Subject | Part C Reporting, Crosswalk |
| Author | CMS |
| File Modified | 2018-03-09 |
| File Created | 2018-03-09 |