Take the proper steps to ensure that you are compliant

RADV audits require extensive work and are difficult to properly perform. Get the support you need from professionals you can trust.

Why are RADV
Audits Important?

With the passing of the Affordable Care Act, RADV audits are going to be a regular task for health plans across the nation. RADV audits require the collection and analysis of large amounts of patient data. It is important for your organization to submit the best data available to the CMS. Don’t take chances with this process because poor audit results can lead to serious problems for your organization.

RADV Services

Our RADV Audit Solution is a comprehensive, turnkey service tailored to help health plans successfully navigate the entire CMS RADV audit process. We manage every detail—from identifying the right sample members to supporting your appeals—ensuring your plan remains compliant, efficient, and audit-ready.

Targeted Sample Selection

Careful identification of sample members from CMS-provided listings to ensure relevance and compliance.

Rapid Medical Record Retrieval

Guaranteed and timely collection of required medical records through our secure retrieval process.

Accurate Coding & Validation

Thorough HCC reviews by certified coders to identify supported conditions and eliminate errors.

Risk Score Adjustment

Precise recalculations of risk scores using verified clinical data for accurate audit outcomes.

Collaborative Audit Review

In-depth pre-submission audit evaluations to ensure data integrity and maximize success.

CMS Appeals Support

Expert assistance with appeal documentation and strategy to defend and justify audit findings.

End-to-End RADV Audit Management

Full end‑to‑end support—from records retrieval and coding to audit submission and appeals—ensuring health plans are audit‑ready.

Expert RADV Audit Support from Start to Finish

At RADV Audits, we specialize in delivering comprehensive support for every stage of the CMS RADV audit process. From gathering patient data and retrieving medical records to selecting the most appropriate documentation and submitting to CMS, our team takes care of it all. Whether you need assistance with a single component or a fully managed solution, we tailor our services to meet your exact needs—ensuring accuracy, compliance, and peace of mind.

Decades of Experience. Unmatched Precision.

With a proven track record that predates the Affordable Care Act, RADV Audits brings unmatched expertise to the table. Our deep understanding of CMS requirements and audit nuances means your organization is in trusted hands. We’re here to alleviate the burden of audits, helping health plans navigate complex compliance demands with confidence and clarity.

End-to-End Expertise. Proven Results.

At RADV Audits, we bring decades of experience and a deep understanding of CMS audit protocols to every engagement. From full-service RADV audits to proactive mock audits, our solutions are designed to reduce your team’s workload, improve coding accuracy, and ensure regulatory compliance. Whether you need support with record retrieval, risk score validation, or audit appeals, our team works as an extension of yours—streamlining the process while protecting your plan’s bottom line.

Trusted by Health Plans Nationwide

With a track record that predates the Affordable Care Act, we’ve supported countless health plans through successful RADV audits and continue to be a trusted compliance partner.

Comprehensive, Custom-Tailored Solutions

We offer flexible services—ranging from full audit management to targeted support—customized to meet your specific needs, deadlines, and compliance goals.

1-2-1.jpg

Mock RADV
Services

In addition to our ability to aid in RADV audits, we also offer our customers an extremely valuable Mock RADV service option. This service is designed to help health plans assess the effectiveness of their Risk Adjustment efforts and tests their preparedness for a RADV audit.

Realistic Audit Simulation

We conduct a full mock RADV audit that mirrors CMS protocols—testing your team’s readiness under real-world audit conditions.

Coding & Documentation Accuracy Check

Our experts assess the accuracy of HCC coding, identify discrepancies, and flag over- or under-coded diagnoses that could affect your audit outcome.

Actionable Performance Report

After analysis, we deliver a comprehensive report outlining strengths, weaknesses, and improvement areas—equipping your team with data-driven next steps.

Let Us Handle Your Audits  Compliance Workload

Focus on what you do best—serving your members—while we take care of the complex, time-consuming RADV audit process. From mock audits to full CMS submissions, we’re here to simplify, support, and succeed together.