Produce and validate preliminary rates.
NCQA HEDIS® Compliance Auditing
HEDIS® COMPLIANCE AUDIT PROGRAM.
The only team perfectly equipped to help yours.
Since 1999, our team at DTS Group has been a trusted leader in the community for HEDIS® audits, delivering quality audits that minimize administrative burdens on your plan. Over the past 20+ years, our experts in healthcare performance auditing have conducted thousands of HEDIS® audits for health insurers across the U.S.
We’re licensed by The National Committee for Quality Assurance (NCQA) and are scheduling NCQA HEDIS® Compliance Audit services for the upcoming cycle. Schedule a consultation today to learn more.
Everything You Need To Know.
Our 6 Steps to Complete HEDIS® Audit Compliance
Detailed Proposal
At DTS Group, compliance starts with a comprehensive proposal, outlining our audit process to help you make an informed decision. Once approved, a customized work plan is created and a dedicated audit team is assigned.
Customized Approach
Our Certified HEDIS Compliance Auditors take a full-service approach to create solutions that fit your unique needs. DTS Group will provide you with the training, facts and information, without burdening your team with excessive administration and management tasks.
Expert Support
By employing only professionals with extensive HEDIS audit and health-care consulting experience, DTS Group can concentrate on delivering results. Subject-matter specialists perform all audit functions, and highly skilled IT and clinical resources review all code and medical records.
Continuous Analysis
Working with DTS Group means full transparency regarding results. We'll assess the completeness and correctness of your data using a variety of techniques and proprietary tools. Feedback is succinct and timely so issues can be identified early in the audit process.
Best-In-Class Tools
To achieve our goal of on-time, complete, and accurate data submissions, we embrace technology to facilitate the audit process.
With industry-leading tools, we ensure all guidelines and specifications are met.
On-Time Reporting
Our schedule will get you through the audit cycle on time. We support all federal, state and other agency-defined reporting requirements, and we'll work with your team to ensure your plan meets all submission timelines.
We've Got Your Back.
HEDIS® Audit Process Cycle
The HEDIS® Audit cycle runs from October to July every year. Our team creates a detailed workplan to complete all steps of the audit process for you. See the complete HEDIS® Audit cycle below to understand where your audit is in the process.
October
Incorporate Update
Incorporate the NCQA October Update to your Technical Specifications.
October
November
Client Meeting
Join us each fall for our annual client meeting.
November
December
Start of Audit Cycle
Kick off the audit cycle and schedule your on-site date.
December
January
Survey Sample Frames and Roadmap Submission
Produce and validate survey submissions and submit Roadmaps.
January
February
On-Site Visit
Conduct on-site visits now through May. Don’t forget your supplemental data!
Quick Tip:
Get the most out of your reporting experience. Top plans leverage supplemental data to document care delivered to members outside of claims and encounter data. It is important to work with your auditor to properly document supplemental data for HEDIS® Audit compliance. Work with our audit teams to ensure a true representation of your plan’s results.
February
March
Supplemental Data Validation
Work with your audit team to approve supplemental data.
March
April
Preliminary Rate Review
April
May
Medical Record Review Validation
Complete hybrid data abstraction and conduct Medical Record Review Validation.
May
June
Submit Final Data
Finalize and submit locked data to NCQA.
June
July - September
Keep Momentum Going
Keep the momentum going, pursue outreach initiatives, investigate new Supplemental Data and plan for next year.
July - September
HEALTHCARE EFFECTIVENESS DATA AND INFORMATION SET.
About the HEDIS® Audit
The Healthcare Effectiveness Data and Information Set (HEDIS®) is an audit used among government regulators, healthcare providers and others for evaluating and bettering the quality of health care plans across the country. The audit is divided into two parts, the first of which assesses a plan’s information systems capabilities, and the second is how they comply with HEDIS specifications.
Only certified auditors and licensed organizations are permitted to perform HEDIS® Audits, which are required for every health plan submitting HEDIS data to NCQA. Learn more about HEDIS Compliance Audit Certification today.
Hear it from the source.
What Our Clients Are Saying
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Richard Perez
Linda O'Donnell
Providence Simon
Trenton Browne
Scott & White Health Plans
YourCare Health Plan
CarePlus Health Plans
Northwest Health
