Commercial Market Risk Adjustment Data Validation (RADV) Audit

This Request for Information (RFI) is seeking information to assist the Washington State Health Care Authority (HCA) in a 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 is interested in understanding the types of vendors or organizations that conduct RADV audits, whether RADV audits can be customized for state employer group medical plans, the potential costs for a population exceeding 500,000 members, and any major business or technical complexities anticipated for this type of audit. The goal is to inform the vendor community of the potential procurement of one vendor to conduct an annual RADV audit for the PEBB and SEBB programs and the framework HCA could use for the design and implementation of this audit. The RFI requests written responses to specific questions and a one-hour conference call with HCA staff. Respondents will not be reimbursed for any costs associated with preparing or presenting responses, and HCA does not have an obligation to issue a solicitation as a result of this RFI.

The procurement is open to all qualified vendors, and HCA does not list any set-aside designations or restrictions on the types of organizations that can respond. The solution procured by HCA will need to comply with applicable state, federal, and industry regulations, such as HIPAA, OCIO security standards, 42 CFR Part 2, and HCA privacy and security policies. HCA does not provide any information about incumbent vendors, current contractors, or existing infrastructure or technology that requires integration. The RFI does not specify any award values or budget ranges.