NCQA HEDIS® Compliance Auditing

NCQA HEDIS Compliance Auditing 1


The only team perfectly equipped to help yours.

Since 1999, we’ve been trusted leaders in the HEDIS® community, delivering quality audits that minimize administrative burdens on your plan. 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.

NCQA HEDIS Compliance Auditing 2
NCQA HEDIS Compliance Auditing 3

Everything You Need To Know.

Our 6 Steps to Complete 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


Incorporate Update

Incorporate the NCQA October Update to your Technical Specifications.


Client Meeting

Join us each fall for our annual client meeting.


Start of Audit Cycle

Kick off the audit cycle and schedule your on-site date.


Survey Sample Frames and Roadmap Submission

Produce and validate survey submissions and submit Roadmaps.


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 compliance. Work with our audit teams to ensure a true representation of your plan’s results.


Supplemental Data Validation

Work with your audit team to approve supplemental data.


Preliminary Rate Review

Produce and validate preliminary rates.

Medical Record Review Validation

Complete hybrid data abstraction and conduct Medical Record Review Validation.

Submit Final Data

Finalize and submit locked data to NCQA.

July - September

Keep Momentum Going

Keep the momentum going, pursue outreach initiatives, investigate new Supplemental Data and plan for next year.
July - September

Hear it from the source.

What Our Clients Are Saying

“DTS Group makes a complex audit easy to navigate. The process is organized logically and my team enjoys working with the professionals at DTS Group. I would not use any other audit firm. Also, their conference is a lot of fun!”
"DTS Group differentiates themselves with amazing customer support. They are available to us 24x7 / 365. Their approach gives us confidence our audit results will be complete and correct. If you are looking for a true partner in compliance reporting then you are in the right place."
"When we selected DTS Group to conduct our audits we gained a skilled partner in performance reporting. DTS Group’s commitment to customer service and our success is unmatched. They are our Five-Star auditors."
“DTS Group works with many 5-Star plans and they understand the pressure and competing priorities we face. They respect my time while we work together to complete the audit. Their efforts are focused, timely, and relevant”
NCQA HEDIS Compliance Auditing 4
NCQA HEDIS Compliance Auditing 5
NCQA HEDIS Compliance Auditing 6
NCQA HEDIS Compliance Auditing 7
Richard Perez
Linda O'Donnell
Providence Simon
Trenton Browne
Scott & White Health Plans
YourCare Health Plan
CarePlus Health Plans
Kaiser Permanente Northwest
NCQA HEDIS Compliance Auditing 8
NCQA HEDIS Compliance Auditing 9
NCQA HEDIS Compliance Auditing 10
NCQA HEDIS Compliance Auditing 11
NCQA HEDIS Compliance Auditing 12


Schedule a Consultation Today