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Contact Us

Rick Potter CPA, MBA
Executive Vice President &
Chief Operating Officer
602.801.6702

Related Information
For more information about HSAG's audit services,
click here.

Healthcare Effectiveness Data and Information Set (HEDIS® ) Compliance

HSAG offers HEDIS® Compliance Audit services, which focus on assisting managed care organizations (MCOs) with reporting valid HEDIS measures. HSAG has been performing NCQA HEDIS Compliance Audits nationwide since 1999. With experience administering HEDIS Compliance Audits across the Medicaid, Medicare, and commercial product lines, HSAG's audit team provides MCOs with valuable expertise and insight to HEDIS protocol and methodology. In addition, HSAG also performs HEDIS Compliance Audits for Preferred Provider Organizations (PPOs) and provides mock-audit services for those gearing up to report HEDIS measures.

HSAG is one of only eight organizations NCQA has licensed to conduct HEDIS Compliance Audits in accordance with the NCQA HEDIS Compliance Auditor Certification Manual and NCQA’s HEDIS Compliance Auditor Standards and Guidelines. HSAG is also one of a handful of organizations that is also an External Quality Review Organization, Quality Improvement Organization (QIO) and a licensed NCQA HEDIS audit firm.

The NCQA HEDIS Compliance Audit includes standards for a thorough assessment of a managed care organization’s information system capabilities and compliance with each HEDIS specification. The goal of the audit is to ensure accurate, reliable, and publicly reportable data that can be used by purchasers and consumers to compare managed care organizations.

HSAG employs a large number of Certified HEDIS Compliance Auditors (CHCAs) who are trained extensively in the audit process. This kind of expertise and credentials has made it possible for HSAG to perform hundreds of HEDIS audits for managed care organizations nationwide since 1999.

HSAG ensures that our clients are completely satisfied with their audit by focusing on reportable data and suggesting solutions so that all measures can be reported. We value each customer's unique needs, and it is our goal to service our clients to the fullest extent throughout the audit process. We truly believe that we are partners with our health plans in producing reportable HEDIS data.

HSAG's unique audit approach adds extra value for audit dollars spent. Based on our audit team members' experiences, HSAG has customized our audit program to make HEDIS reporting a positive, rewarding, and beneficial experience. Here are a few of our value-added services that make us an exceptional auditing organization:

  • Experienced audit team
  • Reportable measures is our goal
  • Flexible timelines
  • Customized audit reports
  • Concurrent audits
  • Audit preparation assistance
  • Practical corrective actions
  • Multi-year discounts
Additionally, HSAG Provides HEDIS Compliance Audit Consulting Services to prepare an organization for submitting HEDIS measures to NCQA or meeting payer or regulatory requirements. HSAG’s consultants provide customized services to help prepare for a successful audit. HSAG’s approach to auditing is educational. Specifically, HSAG focuses on solutions to correct a problem or report a measure. The overwhelming response from health plans is that this approach is rewarding and greatly enhances their ability to meet their goals. We pride ourselves on making each audit experience the best available and we will continue to support our customers through each step of the audit process.

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