Services
Services
Audits
Performance measure and network adequacy indicator validation, expert auditors, and quality improvement experts.
Intent
What we do
HSAG’s audit services assure accurate, reliable, and publicly reportable data that can be used by purchasers and consumers to compare the performance of providers, managed care organizations, and state programs. HSAG is able to serve as your single entity for all of your performance measure-related auditing needs. We offer Healthcare Effectiveness Data and Information Set (HEDIS®) Compliance Audits™, AMP [Align. Measure. Perform.] Audit Review™, Centers for Medicare & Medicaid Services (CMS) Data Validation audits, network adequacy validation (NAV) audits, information system assessments, readiness reviews, and more.1,2,3
Who we serve
HSAG provides audit services for commercial, Medicaid, and Medicare Advantage health plans or other entities interested in performance measure validation and network adequacy validation audit services, including state agencies, provider groups, and health information exchanges (HIEs).
How we implement
HSAG’s audit services are implemented through a customer-centric, highly collaborative approach designed to support transparency, efficiency, and audit quality at every stage of the engagement. We work closely with healthcare organizations from initial planning through final reporting, combining structured, nationally recognized audit standards with flexible, customizable components tailored to each client’s systems, data environment, and reporting requirements.
Our audit process leverages innovative tools, standardized templates, and technology-enabled workflows to assist healthcare entities in collecting, validating, and reporting accurate, complete, and reliable measure rates. These tools are complemented by ongoing communication, clear documentation, and iterative feedback to reduce administrative burden while promoting a smooth and well-coordinated audit experience. Through this balanced approach, HSAG delivers audits that not only meet regulatory and accreditation requirements, but also provide meaningful insights to strengthen data integrity, system performance, and continuous quality improvement.
Why HSAG?
HSAG has conducted more than 3,000 health plan and other performance measure validation audits over the past 25 plus years. This extensive audit experience ensures that we bring a wealth of firsthand knowledge to each client’s audit experience.
Multidisciplinary Expertise
HSAG leverages expertise from HEDIS compliance officers, expert source code reviewers, licensed registered nurses, data analytic experts, and more to ensure a comprehensive audit experience.
Tailored Services
We offer flexible timelines, targeted technical assistance, and standardized audit tools that provide a personalized approach to the audit experience.
Benefits
A unique perspective
Unlike traditional audit firms that focus exclusively on compliance and validation, HSAG brings the perspective of a nationally recognized Quality Improvement Organization (QIO) to every audit engagement. In addition to its extensive audit expertise, HSAG works directly with federal and state agencies, health plans, providers, and communities to improve healthcare quality, safety, and outcomes across the continuum of care.
This unique dual role allows HSAG to evaluate audit findings and performance measure results not only for technical accuracy and regulatory compliance, but also through a quality-focused, improvement-oriented lens. By combining rigorous audit standards with deep expertise in quality improvement science, performance measurement, and program evaluation, HSAG helps organizations understand the “why” behind their results and identify meaningful opportunities for improvement—transforming audits from a compliance exercise into a catalyst for sustainable healthcare improvement.
Benefits
Disparate information sources
HSAG integrates HEDIS rates with complementary performance data, including CAHPS®4 survey results, by leveraging its dual role as a nationally recognized Quality Improvement Organization (QIO) and advanced analytics partner. This capability allows HSAG to combine validated clinical quality measures with experience-of-care insights, producing analytically robust, multi-dimensional assessments of healthcare performance that support program oversight, benchmarking, and targeted quality improvement.
Benefits
A unique perspective
Unlike traditional audit firms that focus exclusively on compliance and validation, HSAG brings the perspective of a nationally recognized Quality Improvement Organization (QIO) to every audit engagement. In addition to its extensive audit expertise, HSAG works directly with federal and state agencies, health plans, providers, and communities to improve healthcare quality, safety, and outcomes across the continuum of care.
This unique dual role allows HSAG to evaluate audit findings and performance measure results not only for technical accuracy and regulatory compliance, but also through a quality-focused, improvement-oriented lens. By combining rigorous audit standards with deep expertise in quality improvement science, performance measurement, and program evaluation, HSAG helps organizations understand the “why” behind their results and identify meaningful opportunities for improvement—transforming audits from a compliance exercise into a catalyst for sustainable healthcare improvement.
Benefits
Disparate information sources
HSAG integrates HEDIS rates with complementary performance data, including CAHPS®4 survey results, by leveraging its dual role as a nationally recognized Quality Improvement Organization (QIO) and advanced analytics partner. This capability allows HSAG to combine validated clinical quality measures with experience-of-care insights, producing analytically robust, multi-dimensional assessments of healthcare performance that support program oversight, benchmarking, and targeted quality improvement.
Currently supported audits
HEDIS Compliance Audits
HSAG provides HEDIS compliance services, which focus on assisting managed care organizations (MCOs) with reporting valid HEDIS measures. HSAG is one of only nine 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.
AMP Audit Reviews
HSAG is a major market leader in providing AMP audit services, conducting hundreds of AMP audits since 2003. Our AMP audit services assist MCOs and physician organizations with reporting valid and reliable AMP measures. Given our experience, we offer organizations a multitude of best-practice scenarios and advice on how to achieve an optimal, reportable rate.
Information System Assessment/Readiness Reviews
These reviews ensure that health plans have the system capacity needed to enroll recipients in expanded service areas and accommodate anticipated increases in enrollment. 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.
CMS Part C and Part D Data Validation
These audits ensure organizations are reporting health and drug plan data that are reliable, valid, complete, comparable, and timely. HSAG uses the CMS-developed reporting standards and data validation specifications to validate data. We also offer data validation pre-assessment services for organizations evaluating their reporting procedures and audit preparation activities with a goal of process improvement.
1 HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
2 HEDIS Compliance Audit™ is a trademark of the NCQA.
3 AMP Audit Review™ is a registered trademark of the NCQA.
4 CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)
Learn More
Audit Services
If you are interested in learning more about HSAG’s Audit Services, please contact us.