Wakely Releases 2017 RADV Preliminary Market Average Error Rates

Wakely Consulting Group, LLC collected 2017 Risk Adjustment Data Validation (RADV) data files from Wakely National Risk Adjustment Reporting (WNRAR) program participants. The data files include issuer’s initial validation audit (IVA) results to estimate national average failure rates for substantiating risk adjustment condition categories (HCC Groups) and their confidence intervals.

Based on these national benchmarks, Wakely also estimated issuer and market-level error rates. The results included data from a total of 456 HIOS issuers who were subjected to the 2017 benefit year RADV program. This study presents the 2017 national level results as well as a comparison to results from Wakely’s 2016 study to examine the trend in the RADV program.

From Chia Yi Chin, leader of the WNRAR initiative at Wakely:

“The participating plans have been really engaged and supportive of this project.  We have been pleased to see them using our results in their comments to CMS related to the Notice of Benefit and Payment Parameters and in internal financial estimates and even operations. We are looking forward to seeing how the ACA RADV program takes shape going forward.”

Full Analysis

Source: Wakely Consulting Group


Categories: Healthcare, Health Insurance


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Wakely Consulting Group is a nationally recognized health care financial and actuarial consulting firm serving health plans, government regulators, employers, health care providers, and other stakeholders in health care.

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