Initial Validation Audit

To learn more, contact:
Jeff Wussow
Business Development Manager
1-800-362-2320 or 1-608-274-1940, ext. 8264

MetaStar Successfully Completes 2016 Initial Validation Audits

MetaStar successfully completed the 2016 Risk Adjusted Data Validation (RADV) Initial Validation Audit (IVA) and met all Centers for Medicare & Medicaid Services (CMS) timelines and deliverables.  MetaStar provided Issuers with a report outlining the hierarchical condition categories (HCC) that were not substantiated to allow for discussion of documentation requirements.  Our experience will assist commercial risk-adjusted health plans through a successful 2017 IVA process.

About the IVA

An Initial Validation Audit (IVA) is required for commercial risk-adjusted health plans as part of the Affordable Care Act.  It is essential a reputable IVA entity is selected to conduct your audit due to the direct impact on the recuperation of Risk Adjustment funds from CMS.  The accuracy and the communication of your audit team are vital to providing you with the most favorable outcomes.

An IVA involves a stratified random sample of 200 members selected by the Centers for Medicare & Medicaid Services (CMS). The health plan provides medical records, support claims and demographic information for these 200 members to their IVA auditor.

Here’s how it works:

  • MetaStar will validate the demographic and enrollment information and claims data from the EDGE data files and the source data files.
  • MetaStar’s certified medical coders will review the medical records to confirm HCC.  MetaStar’s coders are American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) certified and are all based in the United States.
  • We communicate with the issuers throughout the process and allow time to respond to findings.
  • The final audit deliverables will be completed in the CMS audit tool.

Why Choose MetaStar?

MetaStar is an experienced, independent auditor with a strong reputation for high-quality work .  We have more than 17 years of experience providing HEDIS Compliance Audits and we have extensive medical record review experience. We have served as a CMS-designated quality improvement organization for decades.  In addition to certified auditing staff, we have the experienced medical coders required for this audit.

We take a team-based approach to audit services, customized for the needs of each customer. We offer structured, ongoing feedback throughout the progress of your audit. In addition, we provide a customized portal for each customer to facilitate easy and secure file-sharing and communication.

Most importantly, MetaStar will provide you with a report outlining all HCC’s that are submitted to CMS and the HCC’s MetaStar abstracted. This customized report provides you with the opportunity to discuss MetaStar’s findings with your audit team.

What our customers say:

“The customer service was excellent. There were many issues/changes by CMS along the way. Metastar did the best they could with all the unknowns.” – Initial Validation Audit Customer in 2016

Request a proposal

For more information, or to request a proposal from MetaStar, click here.

 

NCQA HEDIS Compliance Audit™ is a trademark of the National Committee for Quality Assurance (NCQA).

MetaStar’s HITRUST Certification is pending.