Crosswalk

Document in
CMS-10717
(OMB Approval
0938-1395
(Expires
05/31/2024))
Part D Coverage
Determinations,
Appeals, and
Grievances
(CDAG), Part C
Organization
Determinations,
Appeals, and
Grievances
(ODAG), and
Special Needs
Plans Care
Coordination
(SNPCC)
Program Audit
Protocol and Data
Request

Original Language

Grammatical changes were made to the following tables that
have no impact on burden.

Clarification or
Change

Revised Language

Technical
Clarification

NA

Only include eligible enrollees for which the
Sponsoring organization does not utilize prior
claims history for purposes of providing transition
supplies. In some cases, the Sponsoring
organization may have the full claims history for
the enrollee from the most recent PBP, and thus,
the Sponsoring organization may be able to
determine new versus ongoing therapy. In this
example, the enrollee should not be included in the
New Enrollee Universe since they are determined
to be a continuing enrollee.
Field Name: Date auto-forwarded to IRE

CDAG Universe Table 6: Part D Standard and Expedited
Grievances (GRV_D)
ODAG Universe Table 2: Standard and Expedited Pre-service
Reconsiderations (RECON)
SNPCC Universe Table 1: Special Needs Plans Enrollees
(SNPE) Record Layout
SNPCC Universe Table 1IA: Care Coordination Impact
Analysis (CC-IA) Record Layout
SNPCC Universe Table 2IA: HRA Timeliness Impact Analysis
(HRAT-IA) Record Layout

FA Program
Audit Protocol
and Data Request
Universe Table 4:
NE Table
Instructions

Only include eligible enrollees for which the Sponsoring
organization does not utilize prior claims history. In some cases,
the Sponsoring organization may have the full claims history for
the enrollee from the most recent PBP, and thus, the Sponsoring
organization may be able to determine new versus ongoing
therapy. In this example, the enrollee should not be included in
the New Enrollee Universe since they are determined to be a
continuing enrollee.

Technical
Clarification –
Added
Langauge

CDAG Program
Audit Protocol
and Data Request
Tables 1 - 4

Field Name: Date forwarded to IRE

Technical
Clarification –
Updated Field
Name

1

Document in
CMS-10717
(OMB Approval
0938-1395
(Expires
05/31/2024))
CDAG Program
Audit Protocol
and Data Request
Tables 1, 2, and 4
CDAG Program
Audit Protocol
and Data Request
Table 3: PYMT_D
Table Instructions
Special Needs
Plans Care
Coordination
(SNPCC) Program
Audit Protocol
and Data Request,
Table 1IA: Care
Coordination
Impact Analysis
(CC-IA) Record
Layout: Column
ID I

Original Language

Field Name: Time forwarded to IRE

Enter all fields for a single request in the same time zone. For
example, if the Sponsoring organization has systems in EST and
CST, all data in a single line item must be in a single time zone.

[Field Length]
1

Clarification or
Change

Revised Language

Technical
Clarification –
Updated Field
Name
Technical
Clarification –
Removed
Language

Field Name: Time auto-forwarded to IRE

Technical
Clarification

[Field Length]
2

NA

2