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IVA Qualifications Qualifications of Initial Validation Auditors The Department of Health and Human Services (HHS) has confirmed a delay in the Risk Adjustment Data Validation timeline, but has not specifically commented on any change to the March 2015 IVA vendor selection deadline. The selection of a qualified IVA is important because they will be evaluating the diagnostic and demographic data of the existing risk adjustment efforts. The data generated by the IVA will be evaluated via a Secondary Validation Audit or SVA. HHS has referred to best practices and standards for independent

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Page 1: Qualifications of Initial Validation Auditors

IVA QualificationsQualifications of Initial Validation AuditorsThe Department of Health and Human Services (HHS) has confirmed a delay in the Risk Adjustment Data Validation timeline, but has not specifically commented on any change to the March 2015 IVA vendor selection deadline. The selection of a qualified IVA is important because they will be evaluating the diagnostic and demographic data of the existing risk adjustment efforts. The data generated by the IVA will be evaluated via a Secondary Validation Audit or SVA. HHS has referred to best practices and standards for independent auditors as noted on the Federal Register:

https://www.federalregister.gov/articles/2014/03/11/2014-05052/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2015#h-34
http://www.hce.org/wp-content/uploads/2015/02/CMSQ.jpg
Page 2: Qualifications of Initial Validation Auditors

Health Care Excel is a Qualified Initial Validation Auditor

• Health Care Excel has over 40 years of audit and compliance experience including diagnosis validation. Our flexible, collaborative approach combined with broad industry experience positions us well to serve as an Initial Validation Auditor (IVA).

Page 3: Qualifications of Initial Validation Auditors

Why choose HCE?• 100% U.S. based AHIMA/AAPC clinical

coders• Flexible services and fees• Regulatory compliance experience• Health plan/provider expertise• Exclusive role as IVA = Absence of

conflict• Independent Review Organization (IRO)

certification in-process• QIO-like entity certified


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