HHS-Risk Adjustment Data Validation (HHS-RADV)
As part of the Affordable Care Act (ACA), all qualified health plans are subject to Risk Adjustment Data Validation (HHS-RADV) Audits. This impacts all commercial insurers on and off the Exchange offering individual and/or small group policies.
HHS-RADV consists of a two-tier approach with Issuers contracting with an independent organization, such as Attest, to perform an Initial Validation Audit (IVA) and CMS contracting with an organization to perform a Secondary Validation Audit (SVA).
Key activities of HHS-RADV include:
Planning Call with the Attest Team
Sample Selection and Release by CMS to the Audit Tool
Phase 1: Creation of Audit Support Documentation by the Issuer
Phase 2: Review and Confirmation of Audit Support Documentation and Mappings by the IVA and Issuer
Phase 3: Demographic and Enrollment Validation
Phase 4: RXC Validation
Phase 5: Health Status Data Validation
Phase 6: Final Reporting, Record Validation Status
Meeting your HHS-RADV Needs:
Attest has been conducting HHS-RADV Initial Validation Audits since the inception of the program in 2015. We are a boutique firm that offers transparency throughout the process and strongly believe in a collaborative process. We are committed to providing you personalized service by actively guiding you through each of the phases and maintaining ongoing communication to work with you to cure errors.
Attest’s IVA audit methodology conforms to the HHS / CMS final rule for Risk Adjustment Data Validation.
Attest Health Care Advisors is an NCQA-licensed organization authorized to conduct HEDIS® audits. Only an NCQA-licensed organization is authorized to conduct HEDIS Compliance Audits™
