Catch Discrepancies Early.

Mitigate CMS RADV Audit Risk.

Avoid Penalties.

Prevent unsupported or invalid diagnosis codes from reaching CMS to protect compliance.

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27001:2022 Certified

We protect your sensitive information with the highest
standards of security and privacy

About RADV Scrubber

RADV Scrubber is a comprehensive platform powered by a rules engine that helps Medicare advantage plans reduce CMS penalty risk by detecting unsupported or invalid diagnosis codes before submission.

60+

High-risk Condition Groups

7,000+

HCC-Associated ICDs

20+

Validations of High-risk Codes

Key Features

RADV Scrubber provides finding comments to internal auditors and seamlessly integrates with both concurrent and retrospective audit workflows.

Flags Non Compliant Members & ICD Codes

Instantly detect invalid or
unsupported ICDs.

Early Risk
Detection

Identify high risk encounters with
RAF scores and flagged ICDs.

Seamless Workflow
Integration

Works with concurrent and
retrospective audit processes.

Empowers Coders &
Auditors

Provides insights to resolve issues
quickly and accurately.

Mitigates Operational &
Financial Risk

Reduces exposure to penalties and
revenue loss.

Supports Audit
Readiness

Prepares data for both
internal and external audits.

Smart Clinical Data Validation

RADV Scrubber automatically spot errors in clinical, demographic, and service data. Easily improve compliance, reduces costly errors, and supports accurate coding and RAF scoring while helping avoid penalties.

Comprehensive Data Validation

Reviews clinical, demographic, and service data to spot discrepancies and ensure compliance CMS risk areas. covering provider details, service, treatments, diagnostics, and other key CMS risk areas.

Validation Issues Detected

Identifies missing or mismatched member and provider specialties, invalid, unsupported, or mutually exclusive diagnosis codes, and conflicting demographics.

Value & Outcomes

Automates discrepancy detection, builds targeted chase lists with flagged members, ICDs, and RAF scores , and streamlines risk adjustment to avoid penalties and maintain compliance.

Key Use Case: Mitigating RADV Audit Risk

RADV Scrubber helps Medicare Advantage plans mitigate audit risk by validating claims, flagging discrepancies for correction, and ensuring accurate diagnoses are submitted to CMS.

Problems:

Medicare Advantage plans face significant RADV audit risk from discrepancies in encounter files and Chart Review Records (CCR), where unsupported or mismatched diagnosis codes may trigger penalties and compliance issues.

Solution:

RADV Scrubber applies clinical validations, flags member and diagnosis discrepancies with clear reasons, and routes issues for retrospective chart reviews, ensuring only validated claims are submitted.

Result:

Medicare Advantage plans reduce audit exposure, avoid costly penalties, and strengthen compliance by ensuring only accurate, validated encounter data or Chart Review Records (CCR) are submitted to CMS.

How It Works

Simplify complex risk adjustment and audit readiness. Our rules engine highlights high risk conditions, enabling teams to prioritize, validate, and submit accurate, compliant data on time.

Access Member Data

Get access to members data either from raw files or the data mart no manual digging required.

Extract & Scrub

For each member, data flows through the CMS RADV Scrubber REST API for fast, automated analysis.

Analyze & Detect

Our rules engine runs comprehensive checks to spot inconsistencies, gaps, and potential compliance risks.

Flag & Prioritize

High risk members and diagnosis codes are automatically highlighted, so your team knows exactly where to focus.

Resolve & Validate

Coders and auditors address flagged issues, confirm accuracy, and ensure everything is submission ready.

Submit with Confidence

Send clean, compliant data to CMS and reduce the risk of costly audit findings

SaaS or On-Premise Solutions — Your Choice

Get the flexibility to deploy in the SaaS for speed or on-premises for control — without compromising compliance.

Streamline your process, avoid penalties, submit with confidence?

See How it works