Risk Adjustment Data Validation (RADV) and the Department of Health and Human Services (HHS) Medical Records Request

Blue Cross Blue Shield of North Dakota (BCBSND) has been notified by The Department of Health and Human Services (HHS) that we are required to participate in an Initial Validation Audit (IVA) for a sample of members both on and off the Health Insurance Exchange (HIX). 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.  This audit is not specific to you or your practice and is not designed to monitor your practice, and your billing or coding patterns.   
BCBSND does utilize a vendor for this audit, the companies we are using are Cognisight for our in-state providers and Inovalon for our out-of-state providers. Providers may receive letters and requests from these two companies that will request your medical records on behalf of BCBSND.

CMS requires each note to be fully legible, signed with credentials and dated. Therefore, Cognisight will review the records you supply to make sure they meet these requirements. A signed attestation from the provider may be requested if these requirements are not met.