We perform an in-depth review of the health plan's information system in order to collect information that documents their efforts to maintain integrity and validity of data. The audit evaluates aspects of the information system environment that specifically affect the plan’s ability to accurately report HEDIS® measures. The plan is required to demonstrate the accuracy and completeness of its primary databases – including claims and encounters, membership and enrollment, provider, and credentialing – as well as the ability to coordinate accurately and safely store the data for HEDIS® reporting purposes.
At the conclusion of the HEDIS Compliance AuditTM, Attest prepares a summary report of the plan’s information systems to support HEDIS® reporting.
Key Findings and Recommendations
The information in this section may be the most valuable aspect of the summary report in terms of helping to improve HEDIS® reporting processes and rates. Key findings and recommendations from the Issue Log are noted.
Information Systems Capabilities Assessment
The review of information systems (IS) is performed to collect information that documents your efforts to ensure the accuracy and completeness of reported HEDIS® rates. Attest reviews your medical coding, claims data, membership data, provider data, data integration, and control procedures. Aligning directly with the HEDIS® Roadmap, each section in the Information Systems Capabilities Assessment enables health plans to think critically about all the data and processes that go into HEDIS® rates.
Evaluation of Computer Programs
In addition to evaluating your information systems, Attest assesses HEDIS® rate calculation programming logic against the HEDIS® Determination (HD) Standards set by NCQA. The Core Set of measures that were evaluated by Attest is listed in this section report. With any major system or process changes within an organization, the HD Standards and Core Set from the previous year can serve as a reminder to update any mappings or source code that may be affected.
Audit Review Tables
Attest includes the audit review tables (ARTs) at the end of the summary report for every HEDIS® submission. These tables include the final reporting status and rate for each HEDIS® measure, organized by submission. The audit review tables provide a quick way to compare rates across submissions for that particular measurement year. They can also be useful for benchmarking and year-to-year rate comparison purposes.
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Attest Health Care Advisors is an NCQA-licensed organization authorized to conduct HEDIS® audits. Only an NCQA-licensed organization is authorized to conduct HEDIS Compliance Audits™.