Crosswalk

EXHIBIT A
CMS 10662 Compliance Review Information Retrieval Form

SUPPORTING DOCUMENT
NAME

CHANGES TO
SUPPORTING DOCUMENT

2023 CMS-10662_Notice of
Assessment_Final_508_ 2023

N/A

ASETT_CMS 10662_ Notice of Compliance
Review_2023_FINAL

1. Header - Changed the PRA# expiration date to
12/31/25.
2. Header for all pages now display the OMB# and PRA
expiration date.
3. Header- Replaced CMS OBRHI Logo with the CMS
OHEI logo.
4. Footer- Additional language added to the PRA
disclaimer regarding time required to complete the
information collection for the compliance review
program.
5. Signature block: Updated CMS office name from
Office of Burden Reduction and Health Informatics
(OBRHI) to Office of Healthcare Experience and
Interoperability (OHEI).
6. Filename of document changed to:
ASHEPS_Compliance_Review_Package_2024_FINAL_C
LEAN
1. Header - Changed the PRA# expiration date to
12/31/25.
2. Header for all pages now display the OMB# and PRA
expiration date.
3. Footer- Additional language added to the PRA
disclaimer regarding time required to complete the
information collection for the compliance review
program.
4. First Page - Replaced CMS OBRHI Logo with the CMS
OHEI logo.
5. Updated page numbering on all document pages.
6. Updated page numbering in the table of contents.
7. Updated URL to Operating Rule in all question sets.

ASETT_cms
10662_Operating_Rule_Response_Attesta
tion_FINAL_2023_

EXPLANATION OF CHANGES

BURDEN
IMPACT

This is an outdated document that is now retired
and will not be used by the Compliance Review
program in the future.
1. PRA Expiration date was extended to 12/31/25.
2. Ensures consistency on all pages.
3. CMS Office of Burden Reduction and Health
Informatics was changed to Office of Healthcare
Experience and Interoperability effective 11/4/24.
4. Language updated to ensure accuracy of time
to completion for information collection for the
compliance review program.
5. CMS Office of Burden Reduction and Health
Informatics was changed to Office of Healthcare
Experience and Interoperability effective 11/4/24.
6. Name changed to distinguish between
previous and current (updated) document.

N/A

1. PRA Expiration date was extended to 12/31/25.
2. Ensures consistency on all pages.
3. Language updated to ensure accuracy of time
to completion for information collection for the
compliance review program.
4. CMS Office of Burden Reduction and Health
Informatics was changed to Office of Healthcare
Experience and Interoperability effective 11/4/24.
5. Corrected a page numbering issue.
6. When page numbers were corrected, the table
of contents needed to be updated to reflect those
changes.

N/A

N/A

Page 1 of 4

SUPPORTING DOCUMENT
NAME

CHANGES TO
SUPPORTING DOCUMENT
8. Filename of document changed to:
ASHEPS_Operating_Rule_Response_Attestation_2024
_FINAL_CLEAN

CMS-10662_ASETT_Assessment_Follow
Up
Request_For_Information_Letter_Final_50
8_2023
CMS-10662_ASETT_Assessment_Notice of
Draft Findings_Report_Final_508_2023

N/A

CMS-10662_ASETT_Assessment_Notice of
Final_Assessment _Final_508_2023

N/A

ASETT_Notice_of_Corrective_Action_

N/A

CMS-10662_Corrective Action Follow up
Letter_508_2023

N/A

CMS10662_NCA_Select_One_Mitigating_Facto
rs_Affirmative_Defenses_Waiver_Support
_Approval_508_2023
CMS10662_Notice_of_Corrective_Action_Clos
ure_508_2023
CMS10662_Notice_of_Corrective_Action_Failu
re_to_Comply_508_2023
CMS10662_Notice_of_Corrective_Action_ReAssessment_508_2023
ASETT_Follow_Up_Request_For_Informati
on_Letter_2024_FINAL

N/A

N/A

N/A

N/A

N/A

None. This is a new document to be used by the
Compliance Review Program.

EXPLANATION OF CHANGES
7. CAQH CORE website changed the location and
URL of all operating rule documents.
8. Name changed to distinguish between
previous and current (updated) document.
This is an outdated document that is now retired
and will not be used by the Compliance Review
program in the future.

BURDEN
IMPACT

N/A

This is an outdated document that is now retired
and will not be used by the Compliance Review
program in the future.
This is an outdated document that is now retired
and will not be used by the Compliance Review
program in the future.
This is an outdated document that is now retired
and will not be used by the Compliance Review
program in the future.
This is an outdated document that is now retired
and will not be used by the Compliance Review
program in the future.
This is an outdated document that is now retired
and will not be used by the Compliance Review
program in the future.

N/A

This is an outdated document that is now retired
and will not be used by the Compliance Review
program in the future.
This is an outdated document that is now retired
and will not be used by the Compliance Review
program in the future.
This is an outdated document that is now retired
and will not be used by the Compliance Review
program in the future.
This letter is sent to a Compliance Review
participant if they do not provide the requested
artifacts for the Compliance Review by the
established due date.

N/A

N/A

N/A

N/A

N/A

N/A

N/A

None

Page 2 of 4

SUPPORTING DOCUMENT
NAME

CHANGES TO
SUPPORTING DOCUMENT

ASETT_Follow_Up_Request_For_Informati
on_Letter_CA_2024_FINAL

None. This is a new document to be used by the
Compliance Review Program.

ASETT_Notice_of_Corrective_Action_2024
_FINAL

None. This is a new document to be used by the
Compliance Review Program.

ASETT_Notice_of_CR_Closure_No_Violatio
ns_2024_FINAL

None. This is a new document to be used by the
Compliance Review Program.

ASETT_Notice_of_Draft_Findings_2024_FI
NAL

None. This is a new document to be used by the
Compliance Review Program.

ASETT_Compliance_Review_Triage_Questi
onnare_CLH_2024_FINAL

None. This is a new document to be used by the
Compliance Review Program.

ASETT_Compliance_Review_Triage_Questi
onnare_HPL_2024_FINAL

None. This is a new document to be used by the
Compliance Review Program.

EXPLANATION OF CHANGES
This letter is sent to a Compliance Review
participant if they do not provide a Corrective
Action Plan (CAP) by the established due date.
This notice is sent to a Compliance Review
participant after all violations are finalized and
initiates Corrective Action for the participant. This
document also establishes a due date by when
the participant must submit a CAP for each
violation found.
This notice is sent to a Compliance Review
participant once all artifacts are received, tested
and reviewed, no violations were found, and
there is no need for corrective action. This is the
final notice sent to the participant and confirms
the Compliance Review is officially closed.
This notice is sent to a Compliance Review
participant once all artifacts are received, tested
and reviewed, and violations are found. The
notice is sent to the participant so they can
respond to the violations prior to corrective
action.
This document is sent to Clearinghouse
Compliance Review participant and returned prior
to requesting artifacts for the Compliance Review.
This allows the participant to disclose what HIPAA
X12 transactions their organization conducts so
the appropriate artifacts are requested for the
Compliance Review.
This document is sent to Health Plan Compliance
Review participant and returned prior to
requesting artifacts for the Compliance Review.
This allows the participant to disclose what HIPAA
X12 transactions their organization conducts so
the appropriate artifacts are requested for the
Compliance Review.

BURDEN
IMPACT
None

Time needed to
draft the
Corrective
Action Plan for
each violation
found.
None

Time needed
respond to any
violations found
(this is an
optional task for
participants)
Time needed to
complete the
questionnaire.

Time needed to
complete the
questionnaire.

Page 3 of 4

SUPPORTING DOCUMENT
NAME

CHANGES TO
SUPPORTING DOCUMENT

ASETT_Compliance_Review_Triage_Questi
onnare_PRO_2024_FINAL

None. This is a new document to be used by the
Compliance Review Program.

ASETT_Notice_of_Compliance_Review_Cl
osure_CA_Completed_2024_FINAL

None. This is a new document to be used by the
Compliance Review Program.

EXPLANATION OF CHANGES

BURDEN
IMPACT

This document is sent to Provider Compliance
Review participant and returned prior to
requesting artifacts for the Compliance Review.
This allows the participant to disclose what HIPAA
X12 transactions their organization conducts so
the appropriate artifacts are requested for the
Compliance Review.
This notice is sent to a Compliance Review
participant once they have completed a CAP and
have provided the necessary CAP verification
artifacts to demonstrate their CAP was
successfully executed for each violation found.
This is the final notice sent to the participant and
confirms the Compliance Review is officially
closed.

Time needed to
complete the
questionnaire.

None

Page 4 of 4