Healthcare Services
Professional Healthcare Services USA
Risk Adjustment & Coding Integrity
HealthSpective delivers end-to-end risk adjustment medical coding services to optimize RAF scores and improve clinical documentation:
-
Prospective Risk-Adjustment Audits - Mock RADV
-
CMS Risk-Adjustment Data Validation (RADV) Audis
-
NCQA/HEDIS Star Rating - CPT II & HCPCS Coding Verification
-
Continuous Monitoring
Quality Measurement & HEDIS® Performance Platform
We assist healthcare organizations with data optimization and regulatory compliance. Our services include:
-
HEDIS Consulting
-
Measure Production, Process, Analysis & Development
-
HEDIS Supplemental Data Conversion
-
NCQA/HEDIS Move to Digital Measures
-
Skilled Nursing Facilities (SNFs) reporting of HEDIS Measures
Audit Readiness & Continuous Compliance Audit
We deliver comprehensive audit and validation services to ensure accuracy, compliance, and regulatory readiness, including:
-
CMS Medicare Part C-D validation audits
-
CMS Skilled Nursing Facilities (SNFs)
-
Data Integrity Audits
-
Special Data Validation Projects
-
Independent Validation Audits (IVA)
Accreditation Readiness & Quality Excellence Program
Our organization supports audit readiness and compliance to enhance quality outcomes and regulatory success:
-
NCQA Health Outcomes Accreditation Program
-
The Joint Commission Audit Readiness & Support
-
CMS Star Rating Support
Pharmacy & Ancillary Accreditation Performance
HealthSpective provides pharmacy accreditation and performance support aligned with various organizations complemented by robust quality reporting:
-
Pharmacy Accreditation & Performance Support
-
NABP®, ACHC®, NCODA®, URAC®, and TCT™ standards
-
-
Quality Management Committee (QMC) Reporting & Analytics Services
Dental Quality & Audit Intelligence
Our solutions are designed to help providers anticipate, identify, and mitigate emerging audit risks through advanced analytics and continuous monitoring.
-
Dental Audits – Dental Management Organizations (DMOs)
-
Medicaid Dental Audits
-
Medicare Advantage Dental Audits