ExchangeAdministrativeMedium impact
Medical Record Requests for the HHS Risk Adjustment Data Validation Program (HHS-RADV)
Healthfirst·Coding
Effective date
May 1, 2021
We identified it
Jun 20, 2026
Summary
CMS is conducting risk adjustment data validation audits for 2020 benefit year services, requiring healthcare providers to respond to medical record requests from health insurance companies. These requests began in May 2021 and require immediate attention from providers to support the HHS-RADV audit process.
Action Required
Immediately: Medical records team must prioritize and respond promptly to any medical record requests related to the HHS-RADV program for 2020 benefit year services. Ensure all requested documentation is complete and submitted within required timeframes to support risk adjustment validation audits.