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

Produce and validate preliminary rates.

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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“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”