Enrollment Data Validation SOPs
ENROLLMENT DATA VALIDATION (EDV) REVIEW PROCESS STANDARD OPERATING PROCEDURE (SOP)
The EDV SOP provides guidance to all applicable organizations on how to provide supporting documentation for the transactions selected for the EDV Review Process. Organizations must comply with CMS Guidelines and Regulations, which include:
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- Medicare Advantage and Part D Enrollment and Disenrollment Guidance.
- Medicare Managed Care Manual of Chapters Chapter 13 – Premium and Cost-Sharing Subsidies for Low-Income Individuals.
- Programs of All-Inclusive Care for the Elderly (PACE) Chapter 4 – Enrollment and Disenrollment.
- Medicare-Medicaid Plan Enrollment and Disenrollment Guidance.
- CMS published Health Plan Management System (HPMS) memos.
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However, organizations must also follow the RPC’s EDV SOP when submitting documentation in response to an EDV Review Request. For your convenience all applicable instructions associated with this process are provided in the Enrollment Data Validation SOP and Toolkit sections and should be used as a step-by-step guide when preparing and submitting supporting documentation. Simply click on the link below to download the SOP.
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