The Affordable Care Act (ACA) led to the creation of the Health Insurance Exchange (HIX) marketplace. As a result, HHS will require that all Qualified Health Plans (QHPs) be validated by external auditors; hence, the establishment of the HHS Risk Adjustment Data Validation program. The primary goal of this program is to mitigate the impact of adverse selection. HDC has been involved in the development of this program for 5 years, and has participated in both pilot seasons. We can help ensure that your risk scores are both accurate and defendable.

How to meet this new requirement

The validation process will help to identify data errors that affect the risk scores. In future years, 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.

For more information on our experience, resources and services, contact: Paul Ackroyd at 717-802-1821 or