Appendix B Crosswalk

CY 2022 DV (2021 Reporting Requirements)
RSC 12.c: Each number calculated for requests for
redeterminations that were withdrawn (Data Element
2.B) and requests for redeterminations that were
dismissed (Data Element 2.C) is a subset of the
number of redeterminations decisions made (Data
Element 2.A).
N/A

CY 2023 DV (2022 Reporting Requirements)
RSC 12 had been changed to RSC 13 before the
PRM.

Type of
Change
Deletion

Reason for
Change
Consistent
with current
technical
guidance.

Burden
Change
None

Update

Consistent
with current
technical
guidance.

None

Update

Consistent
with current
technical
guidance.

None

Deletion

Consistent
with current
technical
guidance.

None

RSC 13.c has been deleted.
DV 2023 Appendix B misaligned RSC 5 standard
definition such that the definition of RSC 5a
appeared next to RSC 5. This has been corrected as
follows:
RSC 5 Organization accurately reports data by
applying data integrity checks listed below and
uploads it into HPMS
5a. Date of MTM program enrollment (Data Element
H) is within the reporting period (between 1/1/2022
and 12/31/2022).
The subsequent RSC codes have been revised to
align accordingly as well.

N/A

RSC 5r definition "If a CMR was received (Data
Element O = Yes), there is a reported delivery
date(s) (Data Element Q ≠ missing)" was repeated
twice in DV 2023 Appendix B. The second instance
has been deleted and the subsequent RSC codes
have been revised to align accordingly as well.

RSC 5v. If a CMR was offered (Data Element N), there RSC 5.v has been deleted.
is a reported recipient of initial offer (Data Element P ≠
missing).  

RSC 5w

RSC code has been revised to RSC 5v

Type of
Change
Update

RSC 5x

RSC code has been revised to RSC 5w

Update

RSC 5y

RSC code has been revised to RSC 5x

Update

RSC 5z

RSC code has been revised to RSC 5y

Update

Consistent
with current
technical
guidance.

None

RSC 5aa

RSC code has been revised to RSC 5z

Update

Consistent
with current
technical
guidance.

None

RSC 5bb

RSC code has been revised to RSC 5aa

Update

Consistent
with current
technical
guidance.

None

RSC 5cc

RSC code has been revised to RSC 5bb

Update

Consistent
with current
technical
guidance.

None

CY 2022 DV (2021 Reporting Requirements)

CY 2023 DV (2022 Reporting Requirements)

Reason for
Change
Consistent
with current
technical
guidance.
Consistent
with current
technical
guidance.
Consistent
with current
technical
guidance.

Burden
Change
None

None

None

CY 2022 DV (2021 Reporting Requirements)

CY 2023 DV (2022 Reporting Requirements)

RSC 5dd

RSC code has been revised to RSC 5cc

RSC 11c. Properly identifies and includes the number
of medication therapy problem resolutions resulting
from recommendations made to beneficiary’s
prescriber(s) as a result of MTM program services
within the reporting period for each applicable member.
For reporting purposes, a resolution is defined as a
change or variation from the beneficiary’s previous
medication therapy. Examples include, but are not
limited to, Initiate medication, Change medication
(such as product in different therapeutic class, dose,
dosage form, quantity, or interval), Discontinue or
substitute medication (such as discontinue medication,
generic substitution, or formulary substitution), and
Medication compliance/adherence (Data Element Z).

RSC 11c. Properly identifies and includes the
number of medication therapy problem resolutions
resulting from recommendations made to
beneficiary’s prescriber(s) as a result of MTM
program services within the reporting period for each
applicable member. For reporting purposes, a
resolution is defined as a change or variation from
the beneficiary’s previous medication therapy.
Examples include, but are not limited to, initiate
medication, change medication (such as product in
different therapeutic class, dose, dosage form,
quantity, or interval), discontinue or substitute
medication (such as discontinue medication, generic
substitution, or formulary substitution), and
medication compliance/adherence (Data Element X).

Type of
Change
Update

Reason for
Change
Consistent
with current
technical
guidance.

Burden
Change
None

Update

Consistent
with current
technical
guidance.

None

CY 2022 DV (2021 Reporting Requirements)

CY 2023 DV (2022 Reporting Requirements)

RSC 5-a.ii. The number of claims rejected due to the
care coordination safety edit (Element C) should be
greater than or equal to each of the following:
• The number of claim rejections overridden by the
pharmacist at the pharmacy (Element D);
• The number of claim rejections overridden by the
pharmacy within 24 hours of the initial claim rejection
(Element E);
• The number of claim rejections overridden by the
pharmacist at the pharmacy that also had an opioid
claim successfully processed at POS (Element F); and
• The number of claim rejections overridden by the
pharmacy as a result of prescriber consultation
(Element G).

RSC 5-a.ii. The number of claims rejected due to the
care coordination safety edit (Element C) should be
greater than or equal to each of the following:
• The number of claim rejections overridden by the
pharmacy (Element D);
• The number of claim rejections overridden by the
pharmacy within 24 hours of the initial claim rejection
(Element E);
• The number of claim rejections overridden by the
due to an exemption (Element F); and
• The number of claim rejections overridden by the
pharmacy as a result of prescriber consultation
(Element G).

RSC 5-a.iii. The number of unique beneficiaries with at
least one claim rejected due to the care coordination
safety edit (Element F) should be greater than or equal
to the number of unique beneficiaries with at least one
claim rejection overridden by the pharmacist at the
pharmacy (Element G) and the number of unique
beneficiaries with at least one rejection overridden by
the pharmacist at the pharmacy that also had an opioid
claim successfully processed at POS. (Element H)

RSC 5-a.iii The number of unique beneficiaries with
at least one claim rejected due to the care
coordination safety edit (Element H) should be
greater than or equal to each of the following:
• The number of unique beneficiaries with at least
one claim rejection overridden by the pharmacy
(Element I)
• The number of unique beneficiaries with at least
one claim rejection overridden by the pharmacy
within 24 hours of the initial claim rejection (Element
J)
• The number of unique beneficiaries with at least
one claim rejection overridden by the pharmacy at
the pharmacy due to an exemption (Element K)
• The number of unique beneficiaries with at least
one claim rejection overridden by the pharmacy as a
result of prescriber consultation (Element L)

Type of
Change
Update

Reason for
Change
Consistent
with current
technical
guidance

Burden
Change
None

Update

Consistent
with current
technical
guidance

None

Type of
Change
Update

Reason for
Change
Consistent
with current
technical
guidance

Burden
Change
None

RSC-8-aii: Includes all methods of coverage
RSC-8-aii: Includes all methods of coverage
determination or appeal receipt (e.g., telephone, letter, determination receipt (e.g., telephone, letter, fax, infax, in-person).
person).

Update

Consistent
with current
technical
guidance

None

RSC-8-aiii: Includes all coverage determination or
appeal requests.

Update

Consistent
with current
technical
guidance

None

Update

Consistent
with current
technical
guidance

None

CY 2022 DV (2021 Reporting Requirements)

CY 2023 DV (2022 Reporting Requirements)

RSC 5-d.ii: The number of claims rejected due to the
opioid naïve days supply edit (Element W) should be
greater than or equal to the number of claim rejections
successfully processed at POS other than through a
favorable coverage determination or appeal, such as
pharmacist communication and/or plan override
(Element X) and the number of claim rejections
successfully processed at POS through a favorable
coverage determination or appeal (Element Y).

RSC 5-d.ii: The number of claims rejected due to the
opioid naïve days supply edit (Element W) should be
greater than or equal to each of the following:
• the number of claim rejections overridden by the
pharmacy due to an exemption (Element X);
• the number of claim rejections overridden by the
pharmacy because the beneficiary was not opioid
naive (Element Y); and
• the number of rejected claims for which up to a 7day supply (covered by the plan) was dispensed by
the pharmacy (Element Z).

RSC-8-aiii: Includes all coverage determination
requests.

RSC-8-bii: Includes all methods of coverage
RSC-8-bii: Includes all methods of coverage
determination or appeal receipt (e.g., telephone, letter, determination receipt (e.g., telephone, letter, fax, infax, in-person).
person).