Skip to main content

Audit and Validation Services (HEDIS®/P4P)

Inside Hospital with Busy Nurses Hispanic Senior Couple
Top

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 Pay-for-Performance (P4P) audit services.

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.

Pay for Performance (P4P)

HSAG is a major market leader in providing Pay-for-Performance (P4P) audit services, conducting hundreds of P4P 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 P4P audits. HSAG’s P4P audit services assist managed care organizations (MCOs) and physician organizations with reporting valid and reliable P4P measures. Based on our experience, HSAG offers organizations a multitude of best-practice scenarios and advice on how to achieve an optimal reportable rate.

New: URAC Pharmacy Organization Performance Measure Data Validation

HSAG is one of seven Data Validation Vendors (DVVs) approved by URAC for pharmacy organization performance measure data validation. HSAG's focus is to ensure accurate and complete data through an Information Systems Capability Assessment (ISCA), rate review, and primary source review of pharmacy measures required for URAC accreditation. HSAG's performance measure data validation services ensure accurate, reliable, and publicly reportable data that can be used by purchasers and consumers to compare organizations. HSAG determines pharmacy organizations' performance measure compliance with URAC reporting instructions and measure specifications.

Information Systems Assessment/Readiness Reviews

HSAG has more than nine years 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.

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).