Medicare AdvantageAdministrativeHigh impact
CMS expands Medicare Advantage RADV audits to all eligible plans
UPMC Health Plan·Provider Announcement
Effective date
Jun 1, 2025
We identified it
Jun 20, 2026
Summary
CMS has dramatically expanded Medicare Advantage RADV audits to include all eligible plans (including UPMC Health Plan) beginning June 2025, increasing medical record requests from 35 to up to 200 records per plan annually. Providers will receive direct requests for medical records covering dates of service from 2018-2023 and must respond promptly to avoid audit penalties.
Action Required
Immediately: Prepare for increased RADV audit record requests from UPMC Health Plan covering 2018-2023 dates of service. Billing team and medical records staff must establish expedited response protocols for audit requests. Ensure complete documentation is readily available for Medicare Advantage patients from 2018-2023. Respond promptly to all record requests to avoid audit penalties and potential payment recoupments.