The validation process will help to identify data errors that affect the risk scores. HDC analyzes demographic and enrollment information and correlates it to issuer source systems. Medical records are reviewed to substantiate Hierarchical Condition Categories (HCCs), and a risk adjustment calculation is performed to identify any changes. HHS will use this process to make financial adjustments between plans. This type of risk adjustment model will generate winners and losers, with some plans receiving more, or less, government funds.

The only approach to safe-guarding your bottom line is to engage with a knowledgeable audit firm and begin the process of data examination and validation. By eliminating inaccurate data (and correcting the processes that produce the data), your organization can prepare for a greater level of stability and confidence. HDC is here to help.