CMS-10394 Phase 2 Application Readiness Checklist

Application To Be a Qualified Entity to Receive Medicare Data for Performance Measurement / Reapplication / Annual Report Worksheet (CMS-10394)

QECP-CHK-Phs2AppRdy

OMB: 0938-1144

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Phase 2 Application Readiness Checklist

Phase 2 Application Readiness Checklist
This checklist helps entities through the Phase 2 application by providing a brief overview of each
application component.
Table 1: Phase 2 Application Readiness Checklist
Element

Readiness Assessment
•

Checkbox

Complete the following tasks and documents:
• Data Security Review

2.1 Data
Security
Review

• Data Flow Diagram with annotations
• Policy and Procedures documents for five control families

[Checkbox]

• Contract with partner/vendor/cloud service provider (CSP), as
applicable
2.2 Non-Public
Analyses
Intentions
2.3 Requests
for Corrections
and Appeals
2.4 Use Secure
Transmission
of Beneficiary
Data

•

Attest intention to provide or sell provider identifier non-public analyses to
authorized users

•

Provide evidence of a Corrections and Appeals process if intending to report
at the provider identifiable level

•

Provide evidence of masking methodology if intending to report at the
regional level

•

Provide evidence of secure transmission of beneficiary data if intending to
report at the provider identifiable level

•

Select NA in engaging in regional reporting

[Checkbox]

[Checkbox]

[Checkbox]

1


File Typeapplication/pdf
File TitlePhase 2 Application Readiness Checklist
SubjectPhase 2 Application Readiness Checklist
AuthorCMS
File Modified2024-01-18
File Created2024-01-15

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