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
Our audit services are built upon a customer-centric, collaborative approach, and leverage innovative tools that assist healthcare entities with collecting and reporting valid and reliable measure rates. With both standardized and custom components, our goal is to optimize the audit experience while minimizing burden for our clients.
Why HSAG?
HSAG has conducted more than 2,500 health plan and other performance measure validation audits over the past 25 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 other audit firms that specialize in just health plan audits, HSAG is a Quality Improvement Organization (QIO), allowing us to evaluate audit and other performance measure results from a unique, quality-oriented perspective.
Benefits
Disparate information sources
We are also able to integrate HEDIS rates with disparate sources of performance information, such as Consumer Assessment of Healthcare Providers and Systems (CAHPS®)4 survey results, by working with a firm that is also a QIO with nationally recognized capabilities in data science and advanced analytics.
Benefits
A unique perspective
Unlike other audit firms that specialize in just health plan audits, HSAG is a Quality Improvement Organization (QIO), allowing us to evaluate audit and other performance measure results from a unique, quality-oriented perspective.
Benefits
Disparate information sources
We are also able to integrate HEDIS rates with disparate sources of performance information, such as Consumer Assessment of Healthcare Providers and Systems (CAHPS®)4 survey results, by working with a firm that is also a QIO with nationally recognized capabilities in data science and advanced analytics.
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 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.
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 AuditTM 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.