30 Day Crosswalk

Document in CMS-10191 (12/27/2019)
CDAG Audit Process Data Request
Table 6, Column K: NDC
Table 8 Column M: NDC

Original Language
Enter the 11-Digit National Drug Code using the NDC 11 format. Remove
special characters separating the labeler, product, and trade package size.
When less than 11 characters or a blank field is submitted by the pharmacy
or delegate, populate the field as submitted.
If the pharmacy submits a value greater than 11 characters, enter
“valueXeeded” in the field.
For multi-ingredient compound claims populate the field with the NDC of
the most expensive drug (or as submitted on the associated PDE). When
compound claims do not include any Part D drug products, populate the
field with “00000000000” consistent with the NDC 11 format.

Clarification or Change
To accommodate at-risk redeterminations, CMS added "or NDC is not
applicable (e.g., for at-risk redeterminations)” to the NDC field description
for CDAG Tables 6 and 8.

Revised Language
Enter the 11-Digit National Drug Code using the NDC 11 format. Remove
special characters separating the labeler, product, and trade package size.

Burden
No
Change

When less than 11 characters or a blank field is submitted by the pharmacy
or delegate, or NDC is not applicable (e.g., for at-risk redeterminations),
populate the field as submitted.
If the pharmacy submits a value greater than 11 characters, enter
“valueXeeded” in the field.
For multi-ingredient compound claims populate the field with the NDC of
the most expensive drug (or as submitted on the associated PDE). When
compound claims do not include any Part D drug products, populate the
field with “00000000000” consistent with the NDC 11 format.

CDAG Audit Process Data Request
Table 6, Column P: Exception Type
Table 8, Column T: Exception Type

Type of exception request. Valid values are: tiering exception, nonformulary exception, formulary UM exception and hospice. Answer NA if
request was not processed as an exception request.

CMS added "safety edit exception" to the "Exception Type" field for CDAG Type of exception request. Valid values are: tiering exception, nonNo
Change
Tables 6 and 8.
formulary exception, formulary UM exception, hospice and safety edit
exception. Answer NA if request was not processed as an exception request.

ODAG Audit Process Data Request
Table 7 , Column K: Date the reconsideration
request was paid
ODAG Audit Process Data Request
Table 1, Column J: Diagnosis
Table 2, Column K: Diagnosis
Table 3, Column J: Diagnosis
Table 4, Column J: Diagnosis
Table 5, Column J: Diagnosis
Table 6, Column K: Diagnosis
Table 7, Column H: Diagnosis
Table 8, Column G: Diagnosis
Table 9, Column G: Diagnosis
Table 10, Column G: Diagnosis

Date the reconsideration request was paid. Submit in CCYY/MM/DD
format (e.g., 2020/01/01). Sponsors should answer NA for untimely cases
that are still open.
Provide the enrollee diagnosis/diagnoses ICD-10 codes related to this
request. If the ICD codes are unavailable, provide a description of the
diagnosis, or for drugs provide the 11-digit National Drug Code (NDC) as
well as the ICD-10 code related to the request.

CMS added “denied or” to the description in Table 7, Field Name ‘Date the Date the reconsideration request was paid. Submit in CCYY/MM/DD
reconsideration request was paid.’
format (e.g., 2020/01/01). Sponsoring organizations should answer NA for
denied or untimely cases that are still open.
CMS updated the description to remove "as well as the ICD-10 code related Provide the enrollee diagnosis/diagnoses ICD-10 codes related to this
to the request" from the Diagnosis field in ODAG Tables 1 through 10.
request. If the ICD codes are unavailable, provide a description of the
diagnosis, or for drugs provide the 11-digit National Drug Code (NDC).

ODAG Audit Process Data Request
Table 4, Column O: Date written notification
provided to enrollee

Date written notification provided to enrollee. Submit in CCYY/MM/DD
CMS updated Table 4, Column O to add, “Answer NA for reconsideration
format (e.g., 2020/01/01). Answer Pending if written notification has not yet requests.”
been provided, but is anticipated to be provided in a forthcoming EOB
notice. Answer Untimely if reimbursement request was not timely paid or
denied.

No
Change
No
Change

Date written notification provided to enrollee. Submit in CCYY/MM/DD
No
format (e.g., 2020/01/01). Answer Pending if written notification has not yet Change
been provided, but is anticipated to be provided in a forthcoming EOB
notice. Answer Untimely if reimbursement request was not timely paid or
denied. Answer NA for reconsideration requests.

Document in CMS-10191 (12/27/2019)
SNP MOC Questionnaire
Questions

Original Language
3. Describe staffing responsibilities for administering HRAs and developing
ICPs.
7. Describe the process of verifying licensure for credentialed personnel.
9. Describe the process for tracking the distribution of MOC training
materials to ICT providers.
10. Describe the internal system utilized for ensuring that ICTs are
comprised of appropriate disciplines, as described in the MOC, and that
ICTs coordinate care and communicate with each other and enrollees
regarding the ICP.
11. If there are ICT meetings where beneficiary ICPs and care coordination
are discussed, what is the period of time expected between initial ICP
development and presentation to the ICT?
12. Describe outreach policy pertaining to HRA administration and ICP
development.
14. What is the period of time expected between HRA (or completion of
outreach efforts if beneficiary is unreachable) and ICP development? If
there are differences in ICP development timing expected based on risk
stratification level, please explain.

Clarification or Change
We have removed questions 3, 7, 9, 10, 11 and 14 from the SNP
Questionnaire. We revised the language in question # 12 to read: “Describe
the outreach policy pertaining to HRA administration and ICP development.
Describe the process for enrollees that cannot or do not want to be
contacted”. We renumbered the remaining questions accordingly.

Revised Language
Burden
Questions 1-2 - No change
No
Change
Renumbering and Revisions:
3. Describe your organization’s internal system utilized for tracking HRAs,
ICPs, and ICT decisions and activities.
4. Does your organization use an acuity scoring system to assess enrollee
severity of illness/intensity of service? If yes, please describe your
organization’s enrollee risk stratification levels and your process for
assigning enrollees to a risk stratification level.
5. Describe the processes when transition of care is documented for a new
enrollee or an enrollee who has experienced hospitalization. How do you
define transition of care?
6. Describe the process for tracking MOC training for ICT-implicated staff
and FDRs.
7. Describe the outreach policy pertaining to HRA administration and ICP
development. Describe the process for enrollees that cannot or do not want
to be contacted.
8. Please identify FDRs that you contract with that conduct SNP related care
coordination activities, such as administering HRAs or outreach.