White Papers

Health Insurance Exchanges – RADV Audit Process

The RADV Audit process in the HIX ("Commercial") sphere has several important differences from Medicare Advantage program

For health plans (insurers) participating in the Health Insurance Exchanges (HIX), one important aspect of the program is the Risk Adjustment Data Validation (RADV) audit.

While the 2015 Commercial RADV audits were indefinitely delayed and ultimately foregone, HHS has indicated its intention to begin a six-stage data validation program.


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