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HHS RADV Initial Validation Audit for Commercial ACA Issuers

ATTAC Consulting Group (ACG), provides HHS-RADV Initial Validation Audit (IVA) Services to Plans requiring the RADV audit for their individual and small group commercial products.

Picking the Right Auditor Partner Can Be Critical

Key to the outcome of your HHS-RADV audit is efficient validation of demographics, enrollment and HCCs.  Critical to meeting this goal is high transparency and cyclic reporting to allow the Issuer to adjust targeting to address gaps throughout the audit.

Why Select ACG as Your Auditor?

The HHS-RADV Initial Validation Audit is more than a coding exercise; it can impact millions of dollars.  ACG is a trusted audit firm that combines experts in each part of audit, including Edge Server data, enrollment, HCC coding and RADV auditing.  Our suite of tools, reports and experienced audit managers provide Issuers the expertise, efficiency, accuracy and outcomes transparency they need for this critical audit.

HHS-RADV Audit Details: ACG has deep experience performing large scale audits and Risk Adjustment (RADV) audits for ACA Issuers and Medicare plans.  Issuers can trust ACG to provide timely feedback using web-based interfaces, gap reporting and analytics and securely managing their data and all reporting to CMS.  Our audit framework includes:

Demographic and Enrollment Validation:

  • Edge Server to source enrollment data validation
  • Deidentification ID with enrollment and claims
  • Original Source Enrollment Documentation
  • Plan of Enrollment, Rating Area and Premium Validation
  • Date of Birth, Sex and Effective Dates
  • Familiar with Major Enrollment Systems

HCC and Provider Analytics to Support Chart Chase:

  • Report ID HCC Diagnosis by All Provider – Member Combinations
  • ID Risk Adjustment Valid Providers With Or Without HCCs
  • Incorporate Plan Provider Contact Data To Drive Chase
  • Report on Open HCCs and Provider Charts Still Available To Validate HCCs Throughout the Audit

Medical Record Acquisition:

  • Flexible Auditor Acquired, Plan Acquired or Shared Chase Options
  • Professional Record Technicians
  • National Capabilities
  • Electronic EMR Extracts
  • Fax or Mail
  • Secure FTP transmission

Medical Record Coding:

  • Web Based Coding Outcome Reporting for Transparency
  • Certified U.S. Based Coders
  • ICD-10 Expertise
  • HCC Experienced Coders
  • Multi-Stage Coding and QA
  • Inter-Rater Reliability Reporting

Plan and HHS Reporting:

  • Real-time Update on Findings
  • Web Interface for Issues Management
  • Detailed Summary Findings To Plan
  • All Medical Records To Plan
  • Upload all Findings to HHS

Secondary Validation Auditor Support:

  • Assembly of all Records and Findings
  • Data Transfers to the SVA
  • Management of SVA Questions and Inquiries
  • All SVA Data Packaged and Provided to the Plan

Reporting and Appeals Support:

  • All Findings and Records Provided To the Plan
  • Charts and Diagnosis Coded by Page and Date

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Contact Us

301 E. Liberty Street, Suite 605
Ann Arbor, MI 48104
T. (734) 214-2990
E. inquiry@attacconsulting.com