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Reviewing Encounter Data Submission Guidance
Collection of Encounter Data from MA Organizations, Section 1876 Cost HMOs/CMPs, MMPs, and PACE Organizations (CMS-10340)
OMB: 0938-1152
IC ID: 246826
OMB.report
HHS/CMS
OMB 0938-1152
ICR 202403-0938-009
IC 246826
( )
Documents and Forms
Document Name
Document Type
Medicare Advantage Supplemental Dental Services Submission Guide 2-28-2024 Clean 1.1 (1).docx
Instruction
Medicare Advantage Supplemental Dental Services Submission Guide 2-28-2024 Clean 1.1 (1).docx
Instruction
Medicare Advantage Dental Validation Report Layout Clean 2-28-2024.docx
Instruction
Medicare Advantage Dental Validation Report Layout Clean 2-28-2024.docx
Instruction
ED_Submission_Processing_Guide_20201009.pdf
Instruction
ED_Submission_Processing_Guide_20201009.pdf
Instruction
Medicare Advantage Supplemental Dental Services Submission Guide Crosswalk 2-28-2024.xlsx
Crosswalk
IC Document
Medicare Advantage Supplemental Dental Services Submission Guide Crosswalk 2-28-2024.xlsx
Crosswalk
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Reviewing Encounter Data Submission Guidance
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
42 CFR 422.310
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
Medicare Advantage Supplemental Dental Services Submission Guide 2-28-2024 Clean 1.1 (1).docx
Yes
No
Printable Only
Instruction
Medicare Advantage Dental Validation Report Layout Clean 2-28-2024.docx
Yes
No
Printable Only
Instruction
ED_Submission_Processing_Guide_20201009.pdf
Yes
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
900
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
900
0
167
0
0
733
Annual IC Time Burden (Hours)
14,400
0
2,672
0
0
11,728
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Crosswalk
Medicare Advantage Supplemental Dental Services Submission Guide Crosswalk 2-28-2024.xlsx
03/14/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.