Appendix J DV Crosswalk_Post 30-Day

CY 2022 DV (2021 Reporting Requirements)
Part D: Coverage Determinations and
Redeterminations
RSC-5.a: [Note: Data Elements 1.A - 1.R relate to
Coverage Determinations, Data Elements 2.A – 2.F
relate to Redeterminations, and Data Elements 3.A and
3.B.1 – 3.B.12 relate to Re-openings]

Part D: Improving Drug Utilization Review Controls

CY 2023 DV (2022 Reporting Requirements)
No Data

Type of
Change

Reason for Change

Burden
Change

No Data

No Data

No Data

RSC-5.a: [Note: Data Elements 1.A - 1.R relate Update
to Coverage Determinations, Data Elements
2.A – 2.V relate to Redeterminations, and Data
Elements 3.A and 3.B.1 – 3.B.12 relate to Reopenings]

No Data

No Data

Consistent with
current technical
guidance.

No Data

None

No Data

CY 2022 DV (2021 Reporting Requirements)
RSC-3: Appropriate deadlines are met for reporting
data (e.g., quarterly).

CY 2023 DV (2022 Reporting Requirements)

Type of
Change

Reason for Change

Burden
Change

Update

Consistent with
current technical
guidance

None

Update

Consistent with
current technical
guidance

None

RSC-3: Appropriate deadlines are met for
reporting data (e.g., quarterly).

Organization meets deadline for reporting annual data Organization meets deadline for reporting
to CMS by 02/28/2022.
annual data to CMS by 02/27/2023.
[Note to reviewer: If the organization has, for any
reason, re- submitted its data to CMS for this reporting
section, the reviewer should verify that the
organization’s original data submissions met the CMS
deadline in order to have a finding of “yes” for this
reporting section criterion. However, if the
organization re-submits data for any reason and if the
re-submission was completed by 3/31 of the data
validation year, the reviewer should use the
organization’s corrected data submission for the review
of this reporting section.]

[Note to reviewer: If the organization has, for
any reason, re- submitted its data to CMS for
this reporting section, the reviewer should
verify that the organization’s original data
submissions met the CMS deadline in order to
have a finding of “yes” for this reporting
section criterion. However, if the organization
re-submits data for any reason and if the resubmission was completed by 3/31 of the data
validation year, the reviewer should use the
organization’s corrected data submission for
the review of this reporting section.]

RSC-6.aiii: Rejected opioid claims are counted at the
unique plan, beneficiary, prescriber, pharmacy, drug
(strength and dosage form), quantity, date of service
(DOS) and formulary-level opioid MME POS edit.

RSC-6.aiii: Rejected opioid claims are counted
at the unique contract, beneficiary, prescriber,
pharmacy, drug (strength and dosage form),
quantity, date of service (DOS) and formularylevel opioid MME POS edit.

CY 2022 DV (2021 Reporting Requirements)
RSC-6.aiv: Properly counts the number of unique
beneficiaries by plan that triggered the care
coordination safety edit and, if applicable, a provider
and/or pharmacy criterion.
RSC-6.biii: Rejected opioid claims are counted at the
unique plan, beneficiary, prescriber, pharmacy, drug
(strength and dosage form), quantity, DOS and
formulary-level opioid MME POS edit.

CY 2023 DV (2022 Reporting Requirements)
RSC-6.aiv: Properly counts the number of
unique beneficiaries by contract that triggered
the care coordination safety edit and, if
applicable, a provider and/or pharmacy
criterion.
RSC-6.biii: Rejected opioid claims are counted
at the unique contract, beneficiary, prescriber,
pharmacy, drug (strength and dosage form),
quantity, DOS and formulary-level opioid MME
POS edit.

RSC-6.biv: Properly counts the number of unique
beneficiaries by plan that triggered the established
hard MME safety edit threshold and if applicable, a
provider and/or pharmacy criterion.

RSC-6.biv: Properly counts the number of
unique beneficiaries by contract that triggered
the established hard MME safety edit
threshold and if applicable, a provider and/or
pharmacy criterion.

RSC-6.ciii:Rejected opioid claims are counted at the
unique plan, beneficiary, prescriber, pharmacy, drug
(strength and dosage form), quantity, and DOS.

RSC-6.ciii:Rejected opioid claims are counted
at the unique contract, beneficiary, prescriber,
pharmacy, drug (strength and dosage form),
quantity, and DOS.

RSC-6.civ: Properly counts the number of unique
beneficiaries by plan that triggered the opioid naïve
days supply safety edit.

RSC-6.civ: Properly counts the number of
unique beneficiaries by contract that triggered
the opioid naïve days supply safety edit.

Type of
Change

Reason for Change

Burden
Change

Update

Consistent with
current technical
guidance

None

Update

Consistent with
current technical
guidance

None

Update

Consistent with
current technical
guidance

None

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-7: From the data set of POS rejects (RSC 6a)
related to the care coordination safety edit the
organization accurately identifies and counts the
number of overridden rejected claims and correctly
uploads the counts into HPMS, including the following
criteria:

RSC-7: From the data set of POS rejects (RSC
6a) related to the care coordination safety edit
the organization accurately identifies and
counts the number of overridden rejected
claims and correctly uploads the counts into
HPMS, including the following criteria:

b: Properly identifies and counts the number of unique
beneficiaries per plan with at least one claim rejection
due to its care coordination safety POS edit and a
pharmacist overridden care coordination safety POS
edit rejected claim.

b: Properly identifies and counts the number
of unique beneficiaries per contract with at
least one claim rejection due to its care
coordination safety POS edit and a pharmacist
overridden care coordination safety POS edit
rejected claim.

Part D: Medication Therapy Management Program
RSC-5.s: If a CMR was not received (Data Element O =
No), there are no reported delivery date(s) (Data
Element Q = missing) unless the CMR summary was
returned via mail, then the reported delivery date
should be the date that the written summary was sent
(Data Element Q ≠ missing).
RSC-5.t

No Data
Deleted

Changed numbering in columns B and C to RSC5.s

Type of
Change

Reason for Change

Burden
Change

Update

Consistent with
current technical
guidance

None

No Data
Deletion

Update

No Data
Consistent with
current technical
guidance

Consistent with
current technical
guidance

No Data
None

None

CY 2022 DV (2021 Reporting Requirements)
RSC-5.u

RSC-5.v

RSC-5.w

RSC-5.x

RSC-5.y

RSC-5.z

CY 2023 DV (2022 Reporting Requirements)
Changed numbering in columns B and C to RSC5.t

Changed numbering in columns B and C to RSC5.u

Changed numbering in columns B and C to RSC5.v

Changed numbering in columns B and C to RSC5.w

Changed numbering in columns B and C to RSC5.x

Changed numbering in columns B and C to RSC5.y

Type of
Change

Reason for Change

Burden
Change

Update

Consistent with
current technical
guidance

None

Update

Consistent with
current technical
guidance

None

Update

Consistent with
current technical
guidance

None

Update

Consistent with
current technical
guidance

None

Update

Consistent with
current technical
guidance

None

Update

Consistent with
current technical
guidance

None

CY 2022 DV (2021 Reporting Requirements)
RSC-5.aa

RSC-5.bb

RSC-5.cc

CY 2023 DV (2022 Reporting Requirements)
Changed numbering in columns B and C to RSC5.z

Changed numbering in columns B and C to RSC5.aa

Changed numbering in columns B and C to RSC5.bb

Type of
Change

Reason for Change

Burden
Change

Update

Consistent with
current technical
guidance

None

Update

Consistent with
current technical
guidance

None

Update

Consistent with
current technical
guidance

None