Truven Health Analytics Releases EDGE Initial Validation Audit Solution for Health Plans

Truven Health Analytics™ announced today the release of an EDGE server Initial Validation Audit (IVA) solution that meets the Affordable Care Act (ACA) requirement for health plans to select a qualified IVA vendor before the current deadline of March 31, 2015.

According to the regulations, health plans must have certified coders review medical records for 200 random members selected by the Centers for Medicare & Medicaid Services (CMS) to ensure the data being sent for payment are accurate and complete. Plans must provide the associated medical records and claims, and are required to hire an independent auditor to validate the membership and risk adjustment information. Truven Health is an IVA-qualified vendor with a solution that meets these requirements.

The Truven Health EDGE Initial Validation Audit solution meets CMS requirements by providing health plans with certified coders to support every stage of the IVA process, including providing up-to-date detailed initial instructions, reviewing EDGE data files to ensure completeness and accuracy, performing chart reviews, and supporting the submission of final audit results. The Truven Health audit and compliance team has more than 20 years’ experience in auditing healthcare claims, and expertise performing claims reviews that include all of the major national insurance carriers and many of the nation’s most widely used third-party administrators. Their medical coders are certified by the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC).

“ACA compliance has been stressful for health plans, but this is one requirement that health plans can’t, by virtue of the law, handle on their own.” said Barb Graovac, senior vice president and general manager at Truven Health Analytics. “Because reviewing medical records is such a critical part of the validation process, health plans need to be careful to select a vendor with the right experience and certification, or they could be opening themselves up to risk.”

The Truven Health EDGE team has been closely tracking with CMS on the EDGE and other exchange-related regulations and has a deep working knowledge of the ACA requirements. In addition to partnering with numerous health plans to submit EDGE server data in time to meet the CMS December deadline and processing records for 1 million members, our team of experts created reinsurance models and implemented the CMS do-it-yourself commercial risk model for health plan clients wanting preliminary reimbursement estimates.

Truven Health has claims databases containing 150 million lives, has been working with health plans for more than 20 years, and counts over 125 health plans, third-party administrators, and related organizations as customers. To learn more about the Truven Health Initial Validation Audit solution, visit http://truvenhealth.com/EDGE-IVA

About Truven Health Analytics

At Truven Health Analytics we are dedicated to delivering the answers our clients need to improve healthcare quality and reduce costs. We are a healthcare analytics company with robust, widely-respected data assets and advanced analytic expertise that have served the global healthcare industry for more than 30 years. These combine with our unique perspective from across the entire healthcare industry to give hospitals, clinicians, employers, health plans, government agencies, life sciences researchers, and policymakers the confidence they need to make the right decisions, right now, every time. With our healthcare-specific expertise and tools for managing complex and disparate data, we understand how to implement and integrate tailored analytics that drive improvement.

Truven Health Analytics owns some of the most trusted brands in healthcare, such as Micromedex, ActionOI, 100 Top Hospitals, MarketScan, and Advantage Suite. Truven has its principal offices in Ann Arbor, Mich.; Chicago; and Denver. For more information, please visit http://truvenhealth.com.