The Right HHS-RADV Audit Partner
Protects Millions in Risk Transfers
Validira from ATTAC Consulting Group is one of the nation's leading ACA HHS-RADV Initial Validation Auditors — serving national, regional, BCBS, and local commercial product issuers. We've audited hundreds of HIOS IDs since the program's first year, and our clients stay with us year after year.
Efficiently validating enrollee HCCs, minimizing error rates, and accurately validating enrollment and drug (RXC) data is critical to your ACA risk adjustment transfers. Validira delivers superior analytics, reporting, and coding transparency to guide you through every phase of the annual audit.
Why Health Plans Choose Validira for ACA HHS-RADV Audits
Refined analytics and audit tools that maximize chart-chase efficiency and reduce chase burden by 30%+
Web-based portal with real-time reporting across every aspect of the audit — available 24/7
Coding approach that identifies ~10% new or more dominant HCCs beyond Edge-filed diagnoses
Experienced audit managers who know the critical issues that drive audit outcomes
100% SVA concurrence — CMS's Secondary Validation Auditor has never disagreed with an ACG finding
— Risk Adjustment Leader, Regional Health PlanThat deserves to be said again — Validira team, your responsiveness and timeliness was so appreciated during the audit.
Comprehensive HHS-RADV Audit Services
Our audit framework covers every phase of the HHS-RADV process — from enrollment validation to SVA support — backed by industry-leading analytics, reporting, and a deeply experienced team.
Demographic & Enrollment Validation
- Re-use previous work papers to minimize Issuer workload when switching auditors
- Edge Server as source for enrollment data validation
- Deidentification ID cross-referenced with enrollment and claims
- Original source enrollment documentation verification
- Plan of enrollment, rating area and premium validation
- Date of birth, sex and effective date confirmation
- Familiarity with major enrollment systems
In-Depth Analytics to Support Chart-Chase Refinement
- ID all HCC Dx provider/member combinations
- Establish chase priorities to maximize efficiency
- ID risk adjustment valid providers with or without HCCs
- Add plan provider contact data to drive chase
- Group common record chases to reduce chase burden by 30%+
- Provide data on open HCCs and provider charts still available throughout the audit
Flexible Medical Record Acquisition
- Auditor-acquired, plan-acquired, or shared-chase options
- Professional record technicians with national capabilities
- Electronic EMR extracts
- Fax or mail intake
- Secure FTP transmission
Outstanding Medical Record Coding
- Certified U.S.-based coders with ACA HCC and HHS-RADV experience
- Extensive training on specific HCCs and diagnosis codes each year
- Multi-stage coding, QA, and IRR monitoring included in single per-chart fee
- Identifies ~10% new or more dominant HCCs beyond Edge-filed HCCs on average
- Transparent coding results, appeals process, and web-based outcome reporting
- 100% SVA concurrence — CMS's SVA has never disagreed with ACG's findings
Plan & HHS Reporting
- Real-time updates on findings via web-based client portal
- Web interface for issues management and rapid two-way communication
- Detailed summary findings delivered to the plan
- All medical records provided to plan
- Upload of all final findings to HHS
Secondary Validation Auditor (SVA) Support
- Full assembly of all records and findings for SVA package
- Data transfers to the SVA managed by ACG
- Management of SVA questions and inquiries
- All SVA data packaged and provided back to the plan
Reporting & Appeals Support
- All final findings and coded records provided to the plan
- Charts and diagnoses coded by page and date for submission clarity
- Post-audit debrief and lessons learned session
