Medicare Advantage Compliance Solution

Automate RADV Audit Risk Detection Before CMS Submission

Precise Health Risk Compass™ RADV Scrubber empowers Medicare Advantage organizations with automated pre-submission compliance validation. Using 20+ validation rule-sets across 60+ high-risk condition groups and 7,000+ HCC-associated ICDs, the platform identifies unsupported diagnosis codes, missing provider specialties, mutually exclusive diagnoses, and demographic inconsistencies before CMS submission.

By flagging non-compliant encounter data and Chart Review Records, organizations gain confidence to submit with reduced audit exposure—avoiding penalties and protecting revenue. Strengthen your RADV audit readiness with comprehensive retrospective risk adjustment validation powered by Retro360 analytics.

20+ Validation Rule-Sets

Comprehensive high-risk code validation for CMS compliance verification

60+ Condition Groups

Validate across high-risk condition categories aligned with CMS RADV focus areas

ISO 27001:2022 Certified

Enterprise-grade security with HIPAA compliance and ISO certification

Core Capabilities

Comprehensive RADV Compliance Validation

From code validation to demographic verification, RADV Scrubber provides end-to-end compliance checks to reduce CMS RADV audit risk and protect revenue.

Code Validation & Flagging

Identifies invalid or unsupported ICD codes across 7,000+ HCC-associated diagnoses with automated flagging for compliance review.

High-Risk Validation Rule-Sets

20+ comprehensive checks on high-risk codes for audit compliance, including clinical appropriateness and documentation requirements.

60+ Condition Groups

Validates data across 60+ high-risk condition categories aligned with CMS RADV audit focus areas.

Provider Specialty Verification

Detects missing or incorrect provider specialty assignments that may trigger CMS audit flags.

Mutually Exclusive Detection

Flags conflicting diagnoses that violate CMS guidelines and hierarchical condition category rules.

Demographic Data Validation

Identifies conflicting or inconsistent demographic information across encounter data and Chart Review Records.

Platform Features

REST API Integration for Automated Scrubbing

Integrate RADV validation directly into your workflow with enterprise REST API capabilities for seamless, high-volume compliance validation.

REST API Endpoint

Seamless integration with existing systems via secure REST API architecture

Batch Processing

Process thousands of records simultaneously with high-performance batch validation

Real-Time Validation

Instant compliance feedback with detailed validation reports and flagged items

HIPAA-Compliant Transmission

Enterprise-grade encryption for all PHI data in transit and at rest

Flexible Deployment

SaaS or on-premises deployment to meet organizational security requirements

Actionable Reports

Detailed reports with specific remediation steps for each flagged compliance issue

Process Workflow

How RADV Scrubber Works

Six streamlined steps from data access to compliant CMS submission

01

Access Member Data

Connect to encounter data and Chart Review Records from your source systems securely

02

Submit via REST API

Submit data to the validation engine through secure REST API integration

03

Analyze Inconsistencies

Automated analysis across 20+ validation rule-sets and compliance checkpoints

04

Flag High-Risk Items

Receive detailed reports highlighting compliance issues and audit risk areas

05

Resolve with Coders

Route flagged items to coding and audit teams for remediation and documentation

06

Submit to CMS

Submit validated, compliant encounter data with reduced audit penalty risk

Key Stakeholders

Who Benefits from RADV Scrubber

From Medicare Advantage plans to coding teams, RADV Scrubber enables proactive compliance management

Medicare Advantage Plans

Reduce CMS audit risk and penalty exposure with automated pre-submission validation across all encounter data and Chart Review Records.

Coding & Audit Teams

Streamline compliance validation workflows with automated flagging and detailed remediation guidance for high-risk diagnosis codes.

Risk Adjustment Teams

Ensure accurate RAF scoring before submission with comprehensive validation that eliminates non-compliant codes and reduces RADV exposure.

By the Numbers

RADV Scrubber Impact Metrics

Comprehensive validation coverage with enterprise-grade security

20+
Validation Rule-Sets

Comprehensive high-risk code validation for CMS compliance

7,000+
HCC-Associated ICDs

Complete coverage of HCC-mapped diagnosis codes

60+
Condition Groups

High-risk condition categories aligned with CMS focus areas

ISO 27001
Certified Security

Enterprise-grade security with HIPAA compliance

Start Scrubbing Claims for RADV Compliance Today

Reduce CMS audit penalties with automated pre-submission validation

Schedule Your RADV Scrubber Demo