Commercial Market Risk Adjustment Data Validation (RADV) Audit

Background
The Washington State Health Care Authority (HCA) is seeking information through this Request for Information (RFI) to assist in the potential procurement and implementation of a vendor to perform a Risk Adjustment Data Validation (RADV) audit for the Public Employee Benefits Board (PEBB) and School Employee Benefits Board (SEBB) programs.

HCA conducts annual settlement calculations for participating carriers in these programs, which involve assessing the risk of non-Medicare eligible populations enrolled in their plans. Currently, HCA does not audit the claims data submitted by carriers but is exploring the implementation of RADV audits to enhance accuracy in these calculations.

Work Details
The RFI aims to gather insights from vendors regarding:
1. Types of organizations that conduct RADV audits;
2. Customization of RADV audits for claims data specific to state employer group medical plans;
3. Cost assessment methods and potential annual costs for a population exceeding 500,000 members;
4. Anticipated business and technical complexities related to conducting such audits.

The goal is to potentially procure one vendor to conduct an annual RADV audit for PEBB and SEBB programs, along with establishing a framework for the design and implementation of this audit.

Period of Performance
The RFI was released on September 6, 2024, with no specified period of performance as this is an information-gathering request rather than a contract solicitation.

Place of Performance
The services will be performed in relation to the Public Employee Benefits Board (PEBB) and School Employee Benefits Board (SEBB) programs within the state of Washington.