It is that time of year!
The Medicare Advantage Risk Adjustment Data Validation (RADV) program is the Centers for Medicare & Medicaid Services (CMS) primary way to address improper overpayments to Medicare Advantage Organizations (MAOs). During a RADV audit, CMS confirms that any diagnoses submitted by an MAO for risk adjustment are supported in the enrollee's medical record.
Based on the governmental mandated audit, it is a provider’s obligation to provide medical records or obtain records from your vendor and submit the requested medical records with no charge to Cognisight or ComplexCare Solutions (formerly Inovalon). Please do NOT mail, fax, or email any invoice/pre-payment invoice requests and communicate with your medical records request vendor if your organization uses one.
For additional information related to our upcoming RADV audit refer to our June 2024 Provider Quarterly Insights RADV article.
This audit does not apply to the North Dakota Medicaid Expansion program.
Questions?
If you have any questions and/or prefer to provide access to medical records via electronic medical record (EMR) or secure file transfer, please contact:
- Cognisight at 1-877-271-1657 (option #1)
- ComplexCare Solutions at 1-800-390-3180
