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Deep expertise, flexible options
The Centers for Medicare & Medicaid Services (CMS) and Department of Health & Human Services (HHS) are required to audit diagnosis data submitted by health plans. Preparing for and undergoing a CMS or HHS RADV audit can be a massive task. We provide support every step of the way.
CMS- or HHS-targeted risk adjustment data validation:
- Analyze data and identify targeted medical records
- Retrieve, code and score records
- Prioritize records and submit to CMS or HHS
- Determine and collect attestations
- Report on audit results
National sample RADV audit support:
- Optional service is a subset of the CMS- or HHS-targeted RADV service
- Includes same services offered for the CMS- or HHS-targeted RADV service listed above
- Flexible options based on client needs
- Dedicated project management and RADV audit team
- Client-focused and communicative throughout engagement
Other audit services
Optum Claims Verification service is a process to:
- Review accuracy of hierarchical condition categories (HCC) submitted by claim data
- Compare to coding results from Optum Chart Review service
The service allows both prospective and retrospective charts to be evaluated for eligibility.
For clients performing a self-audit, we offer internal data validation review services.