Invalid Data Submission (IDS) in 2026: What You Need to Know
Sevana Health Team
January 24, 2026
When CMS released the 2026 Program Audit Updates, most attention focused on the elimination of audit scoring and the retirement of ICAR/ORCA classifications. But there's one classification that didn't go away, and in many ways it just became more consequential: Invalid Data Submission (IDS).
For Medicare Advantage and Part D plans, understanding IDS and how to prevent it should be a top priority heading into the 2026 audit cycle.
What Is an Invalid Data Submission?
An Invalid Data Submission occurs when a plan fails to provide CMS with accurate or complete universe files during an audit. When auditors cannot determine compliance because the data itself is flawed, they issue an IDS finding for each audit element that couldn't be tested.
The mechanics are straightforward: CMS gives plans up to three attempts to submit accurate universe files. If after three attempts the files still don't pass integrity testing, CMS cites an IDS condition.
Why IDS Matters More in 2026
Under the new 2026 audit framework, CMS simplified finding classifications into three categories:
Observation
Noncompliance that does not require a corrective action plan.
CAR
Corrective Action Required
Noncompliance requiring remediation to prevent recurrence or address enrollee impact.
IDS
Invalid Data Submission
When a plan cannot provide accurate or complete universes or documentation.
With ICAR and ORCA retired, the classification landscape is simpler. But that simplicity means there's no longer a gradation of severity within findings. Every CAR matters. And IDS sits in a category all its own.
An IDS finding signals something more fundamental than a compliance gap in processing appeals or grievances. It tells CMS that your organization may not have the data infrastructure, governance, or operational discipline to demonstrate compliance at all.
What Triggers an IDS Finding
Universe file validation failures generally fall into several categories:
Header and Format Errors
- Missing or incorrectly formatted column headers
- Wrong file format (CMS specifies Excel xlsx requirements)
- Data elements not matching the required record layout
- Time zone inconsistencies within the same record
Data Integrity Issues
- Cases included from outside the audit review period
- Member ID mismatches (using internal IDs instead of Medicare Beneficiary Identifiers)
- Duplicate records or missing required cases
- Incorrect categorization of case types
Timeliness Calculation Errors
- Missing time stamps on expedited requests
- Omitting receipt times for Part B drug requests
- Extensions not properly documented, skewing calculated timeliness
- Verbal notification dates recorded when no verbal notice occurred
Completeness Problems
- Universe doesn't include all applicable cases
- Missing data from delegated entities (TPAs, PBMs, supplemental benefit vendors)
- Incomplete documentation chains
The challenge is that many of these errors only surface during audit, often too late to remediate without triggering the IDS classification.
The Three Strikes Reality
CMS's three attempt policy sounds forgiving until you experience it during a live audit. Here's what actually happens:
Attempt 1
You submit your universe files within 15 business days of the engagement letter. CMS conducts a desk review and identifies issues. Maybe your ODAG files have timeliness fields that don't match source system data, or your CDAG universe is missing cases from a delegated PBM.
Attempt 2
You scramble to resubmit. Your compliance team pulls data again, works with IT, coordinates with delegates. The clock is ticking. CMS reviews and finds additional issues, or the same issues persist because the root cause wasn't truly fixed.
Attempt 3
Final chance. If your files still don't pass integrity testing, CMS cites IDS for each element they couldn't evaluate.
The window between attempts is measured in days, not weeks. Plans that haven't validated their universe generation processes before audit notice day often find themselves in an unrecoverable position.
The Real Cost of IDS
You Can't Prove Compliance
If CMS can't test your data, they can't verify you're meeting regulatory requirements. The finding effectively becomes a statement that compliance cannot be determined.
Validation Audit Complications
Under the 2026 changes, plans receiving IDS must produce the universes that auditors were unable to test during the validation audit. This extends your remediation timeline and creates additional scrutiny.
Systemic Issues Exposed
IDS findings often indicate deeper problems: fragmented data systems, poor delegate oversight, manual processes that introduce errors, or insufficient validation before submission. These same issues can affect Star Ratings, member experience, and operational efficiency.
Resource Drain
The reactive scramble during audit fieldwork (pulling staff from other projects, emergency calls with TPAs, weekend data reconciliation sessions) is costly and unsustainable.
Preventing IDS: A Validation First Approach
The most effective strategy for avoiding IDS is straightforward in concept but requires operational commitment: validate your universe files continuously, not just when CMS comes calling.
Key Prevention Strategies
- 1.Understand CMS Technical Specifications — CMS publishes detailed record layouts and data dictionaries for ODAG, CDAG, FA, SNPCC, and CPE universes. Your validation process must check against all of them.
- 2.Validate at the Row Level — High level checks aren't enough. Every row in your universe file must pass validation: correct MBI format, dates within the review period, required fields populated, timeliness calculations accurate.
- 3.Test Timeliness Calculations Independently — Timeliness is evaluated at the universe level. CMS doesn't sample for timeliness; they review every applicable case. Your validation must replicate CMS's timeliness logic exactly.
- 4.Include Delegate Data Early — Many IDS findings stem from data gaps involving delegated entities. If your PBM or TPA provides data for your universes, validate that data with the same rigor as internal data.
- 5.Run Mock Audits — Simulate the audit process quarterly. Generate universes, run them through validation, sample cases, and test documentation availability. Identify gaps before CMS does.
How Automation Changes the Equation
Manual universe validation (reviewing files in spreadsheets, spot checking records, manually calculating timeliness) worked when audit protocols were simpler and tolerances were higher. It doesn't scale to today's requirements.
Automated validation changes three things:
Speed
What takes hours manually takes seconds with automated rules. You can validate files immediately after generation and catch errors in real time.
Consistency
Automated validation applies the same rules to every file, every time. No variation based on who's reviewing, no rules missed because of time pressure.
Auditability
Automated systems generate validation reports that serve as evidence packages. You can demonstrate that you have a systematic process for ensuring accuracy.
What This Means for 2026 Audit Prep
If your organization is subject to CMS program audits, the time to address IDS risk is now, before engagement letters arrive in February.
- •Audit your audit process. How do you currently generate universe files? How do you validate them before submission? What's your error rate on first submissions?
- •Assess delegate data quality. Are your TPAs and PBMs providing complete, accurate data in the formats you need? Do you have visibility into their compliance performance?
- •Identify manual process risks. Where does manual data entry or manipulation occur in your universe generation workflow? These are your highest risk areas for IDS.
- •Implement validation automation. Whether through internal development or specialized tools, establish automated validation that runs against current CMS specifications.
The 2026 audit framework's simplicity is deceptive. With fewer classification categories, there's less room to absorb minor issues. IDS findings represent a fundamental failure mode that's entirely preventable with the right processes and tools in place.
Prevent IDS Before It Happens
Our CMS Universe Scrubber validates ODAG, CDAG, FA, SNPCC, and CPE files against 1,600+ rules aligned with CMS specifications. Get instant validation results and catch errors before CMS does.