RADV & Validation Audits

Address All CMS Audit Variables for ACA RADV and Improve Future Risk Scores

Altegra Health is among a limited number of partners with fully trained and experienced staff to support all aspects of Affordable Care Act Risk Adjustment Data Validation (ACA-RADV) Initial Validation Audit (IVA) requirements. Our IVA services address all level of details and documentation needed in a sound risk adjustment strategy. Our demonstrated experience with Medicare Advantage RADV, provider claim data audit and experience certified coder recruiting navigated the complex process and data relationships extending from medical records and billing/practice management systems all the way through claims clearinghouse and claims adjudication systems.

HHS ACA RADV Initial Validation Auditor Service. Altegra Health’s IVA team is experienced in both general audit requirements and medical record validation audits. Built upon our foundation in the HHS risk model and EDGE server data submission, our IVA process supports the most challenging data environments.


Webinar: What You Can Do to Prepare for Your 2016 IVA

Description: Preparing for a 2016 Initial Validation Audit is all about organization, process and data quality. Learn the steps you need to take to be absolutely certain that you are ready for your IVA.

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8 Ways to Be Sure You Select the Best ACA-RADV IVA Auditor

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Solution Features

  • Enrollment Validation – Review source documentation by enrollee and validate date of birth, gender and plan ID.
  • Claims Validation – Validate that risk adjusting claims were paid for dates of service through the specific metal level plan that corresponds to the enrollment validation. Identify unsubmitted risk adjusting diagnoses.
  • Medical Record Validation – Compare EDGE server data to the medical record and validate risk adjusting diagnoses codes by provider and date of service. Conduct a true medical record validation audit using our medical record auditors.
  • Recalculate the Risk Score/Audit Outcomes – Recalculate each enrollee’s risk score based on found errors.
  • Inter-rater Review – Review all errors with senior reviewers, all of which meet the experience requirements.
  • Secondary Validation Audit (SVA) Support – Receive all needed support from Altegra Health as the team provides the SVA with required elements of a IVA error report, as well as all original documentation to support initial sub-sample requests.
  • Appeals – Count on Altegra Health to provide supporting documentation as needed if an appeal is pursued.
  • Service Delivery Staffing Model – Gain an experienced project management team and a subject matter experts in various areas of healthcare operations including, but not limited to: claims data review, medical record documentation, education and training, and any technical skill required to complete the project,