Commercial Market Risk Adjustment Data Validation (RADV) Audit

The Washington State Health Care Authority (HCA) is issuing a Request for Information (RFI) for a potential procurement to engage 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. The objective of the RADV audit is to validate the risk adjustment data used to determine payments to health plans in the PEBB and SEBB programs. HCA is seeking information from the vendor community on the types of vendors that conduct RADV audits, whether RADV audits can be customized for state employer group medical plans, how costs are assessed, and any major business or technical complexities. The RFI provides details on the response format, which includes a written response and a conference call with HCA personnel. The RFI also covers administrative terms and conditions, such as security and privacy requirements. The potential procurement and implementation of the RADV audit vendor is expected to occur by November 15, 2024.

The RFI covers jurisdictions across the state of Washington, including various counties, cities, and census-designated places. There are no set-aside designations or restrictions on the types of organizations that can respond to the RFI. HCA does not provide any information on incumbent vendors or current contractors, or the expected award value or budget range for the potential procurement.