Your Plan Was
Selected.
Now What?
You have 5 months to retrieve, validate, and submit medical records to CMS. Sample sizes are up to 200 enrollees per contract. And PY2021 audits are expected to launch in Q2, before your PY2020 submission window even closes.
The plans best positioned will be those that move quickly with experienced external partners.
RADV Coding Is Fundamentally Different
Many plans underestimate how different MA RADV HCC validation coding is from standard retrospective coding, and that's where plans get into trouble. Your existing internal coding team may not be equipped for what this audit actually requires.
CMS May Sample Up to 200 Enrollees Per Contract for PY2020
In PY2019, CMS sampled just 35 enrollees per contract. For PY2020 and beyond, CMS may move to up to 200 enrollees per contract, a nearly 6x increase in volume. For larger contracts, this means hundreds of charts, thousands of dates of service, and a need for validated surge capacity your internal team simply may not have.
This Isn't One Audit.
It's 18 Months of Overlapping Pressure.
CMS has announced plans to restart MA RADV audits on an expedited, cascading schedule, with a new payment year launching approximately every 3 months. Plans with multiple contracts will face nearly simultaneous audits across multiple payment years.
Built for MA RADV. Ready Right Now.
Validira from ATTAC Consulting Group is a specialized RADV Coding and Audit Management solution, not a generic coding shop repurposed for audit season. We've been doing this for nearly a decade, and our entire infrastructure is designed for the complexity of MA RADV.
ATTAC has been a game-changer for us. They are agile, responsive, and willing to bend over backwards to provide us with what we need. Compared to past audit partners, the experience has been night and day. We only wish we had brought them on sooner.
You're Working With RADV Specialists
Our Validira leadership team brings decades of MA RADV experience, not generalists who've been reassigned. Every lead on your engagement has done this before, many times over.
Let's Talk About
Your PY2020 Audit
Our team is ready to move immediately. A 30-minute call is all it takes to understand your contract situation and outline how Validira can support your audit response.
Frequently Asked Questions
Everything your Risk Adjustment team needs to know about navigating a PY2020 MA RADV audit selection.
Once selected, CMS provides approximately 5 months for plans to retrieve and submit substantiating medical records for each sampled enrollee. Plans must identify, retrieve, code, and validate records for all HCCs attributed to each targeted member, then determine which records to submit to CMS. The clock starts immediately upon notification.
CMS may sample up to 200 enrollees per MA contract for PY2020, compared to just 35 in the PY2019 cycle. Larger sample sizes are expected for contracts above approximately 1,250 members. This nearly 6x increase in volume dramatically changes the resource demands on plans.
MA RADV HCC validation coding requires coders to document every instance of an HCC on every date of service within a record, rank documentation quality on a 1-3 scale, evaluate which two records per HCC are strongest for CMS submission, and identify any previously unsubmitted HCCs. Standard retrospective coding typically captures an HCC once on a single date of service — making RADV coding significantly more specialized and time-intensive.
CMS announced in January 2026 it would audit payment years 2020 through 2024 on an expedited schedule, launching a new payment year audit approximately every three months. This creates near-continuous overlapping audits through an estimated July 2027, with two audits running simultaneously for most of that period — on top of routine risk adjustment submission cycles.
Validira from ATTAC Consulting Group provides comprehensive MA RADV support: HCC validation coding via an NLP and AI-enabled platform, medical record retrieval, RADV Cycle Management Reporting with 24/7 portal access, coding quality assurance, documentation strength ranking to guide record selection, and dedicated audit management with weekly status updates.
Validira maintains pre-audit readiness so that upon notification of a CMS audit, the team can begin receiving member data, claims, diagnosis, and provider information within days. Pre-configured data exchange pathways, portal access, and coder training protocols allow for rapid launch with minimal ramp-up time on your end.