Risk Adjustment Data Validation Medical Records Requests

Blue Cross Blue Shield of North Dakota (BCBSND) is required by the Department of Health and Human Services (HHS) to participate in an annual Initial Validation Audit (IVA) for a sample of our members both on and off the Health Insurance Marketplace. This audit is not specific to you or your practice. Cognisight is the IVA vendor selected to gather medical records on behalf of BCBSND. You can expect to receive faxed medical record requests beginning in March 2021.
This is a government-mandated audit. As part of your participation agreement, medical records are required to be submitted at no cost when requested by BCBSND or on behalf of BCBSND. As part of the agreement, you are obligated to:

  • Provide medical records or obtain records from your vendor
  • Submit the requested medical records within the timeframe indicated
  • Not invoice for requested records

All Blue Cross Blue Shield plans are required to use Inovalon to retrieve medical records from providers in other plans’ service areas. You can also expect to receive medical record requests from Inovalon on behalf of other Blue plans whose members are your patients.