Initial Validation Auditor Functions

Issuers are required to contract with an independent auditor, known as Initial Validation Auditor (IVA), to validate enrollee risk scores. Firms selected as the Issuer’s IVA must be without conflict related to the risk adjustment process. Valiant Health can partner with you to provide the hands-on support you need and the IVA services you require. Our flexible, collaborative approach combined with broad industry experience positions us well to:

      • Validate enrollee demographics (age/sex) using source enrollment data
      • Validate enrollee health status/risk scores using medical records
      • Calculate inter-rater reliability score
      • Provide HHS with final results and information for Second Validation Audit (SVA)

Issuers must engage an IVA firm early in the process to ensure:

      • Widest available selection of reputable and independent IVA auditors
      • Meeting HHS deadlines for IVA appointment
      • Optimization of record retrieval and processing
      • Methodical Hierarchical Condition Category (HCC) assignment
      • Meeting IVA deadlines for medical record submission
      • Timely submission of IVA report

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