Part C and Part D data validation contractor

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A majority of Medicare Advantage and Part D sponsors currently choose Milliman for Medicare consulting services because of its independence, its technical acuity, and its comprehensive knowledge of the industry—the same reasons they will rely on Milliman to be their data validation contractor.

Milliman's data validation team will be working with Part C organizations and Part D sponsors as a qualified independent contractor to perform yearly audits of Part C and Part D measures in accordance with CMS specifications.

To become a Part C and Part D data validation contactor is a natural progression for Milliman. Currently and over the last 60 years Milliman has provided its clients:

  • Actuarial certifications
  • Medicare bid support
  • Medicare Part C and Part D mock audits
  • Medical and pharmacy claims audits
  • Medical record reviews
  • Data validation

Many organizations present themselves as qualified to meet CMS draft data validation contractor requirements. Milliman is among the few that not only meets the requirements, but also understands the intricacies of health plan data, the Medicare Part C and Part D regulatory requirements, and how these requirements are implemented in health plan operations.

Milliman expertise comes from its cross-functional team of data validation consultants including:

  • Former Medicare Advantage health plan executives
  • Consultants with hands-on experience managing Part C and Part D programs
  • Business analysts with Medicare Part C and Part D regulatory, operations, reporting, and auditing expertise
  • Clinicians with hands-on Medicare Advantage experience and medical record review expertise
  • Information technology (IT) experts that deal with all types of health plan data and programming specifications every day
  • Statisticians that understand health plan data
  • Consultants and analysts with HEDIS and other data metric validation experience
  • Staff with knowledge of managed care and pharmacy benefits operations

In addition to functioning as a data validation contractor, Milliman consultants offer a variety of Medicare services including actuarial support, application and data submission guidance, and audit preparation.