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Audit and Validation Services (HEDIS®/AMP)

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HSAG's audit services assure accurate, reliable, and publicly reportable data that can be used by purchasers and consumers to compare managed care organizations (MCOs). HSAG is also a major market leader in providing Align. Measure. Perform. (AMP) Audit Reviews™.

Healthcare Effectiveness Data and Information Set (HEDIS®) Compliance

HSAG offers HEDIS® Compliance Audit services, which focus on assisting managed care organizations (MCOs) with reporting 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.

Align. Measure. Perform. (AMP)

HSAG is a major market leader in providing AMP audit services, conducting hundreds of AMP audits since 2003. Due to an increase in national interest, which is steering more organizations to assess provider performance, it is imperative that organizations have a reliable and experienced audit firm to conduct AMP audits. HSAG’s AMP audit services assist managed care organizations (MCOs) and physician organizations with reporting valid and reliable AMP measures. Because of our experience, HSAG offers organizations a multitude of best-practice scenarios and advice on how to achieve an optimal reportable rate.

Information Systems Assessment/Readiness Reviews

HSAG has a decade of experience conducting readiness reviews and auditing healthcare provider information systems at the MCO level, individual provider level, and state agency level. These reviews ensure that plans have the system capacity needed to enroll recipients in expanded service areas and accommodate anticipated increases in enrollment.

CMS Part C and Part D Data Validation

HSAG has over a decade of experience conducting Part C and Part D audits for Medicare Advantage Organizations that are contracted to offer Medicare Part C and Part D benefits. HSAG uses the CMS developed reporting standards and data validation specifications in order to validate data reported to CMS. The audits, that are performed on a yearly basis, ensure the organizations are reporting health and drug plan data that are reliable, valid, complete, comparable, and timely. HSAG also offers Data Validation pre-assessment services for organizations interested in evaluating their reporting procedures and DV audit preparation activities with a goal of process improvement.

Audit and Program Evaluation Additional Services

  • CMS Risk Adjustment Data Validation
  • NCQA Wellness and Health Promotion (WHP) Accreditation/Certification Audited Performance Measures for WHP Standard WHP12
  • CMS Medicare Star Ratings Improvement
  • EHR/EMR Data Validation
  • Marketplace Quality Rating System (QRS) Compliance Audits
  • Readiness Preparation for a Variety of Regulatory Audits—CMS Program Audits
  • Medicare Independent Auditor Validation
  • Consulting
  • Health and Human Services’ Risk Adjustment Data Validation Initial Validation Audits (HHS RADV IVAs)
AMP Audit Review™ is a trademark of the National Committee for Quality Assurance (NCQA).
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
NCQA HEDIS Compliance Auditis a trademark of the National Committee for Quality Assurance (NCQA).