Provide Records To Support Risk Adjustment Data Validation Audits for Medicare Advantage
AI Summary
Blue Cross and Blue Shield of Texas will be requesting medical records from Medicare Advantage providers to support CMS Risk Adjustment Data Validation (RADV) audits beginning March 2026. Providers must respond promptly to medical record requests from Advantmed (BCBSTX's vendor) for sampled patients from payment years 2020, 2021, 2023, and 2024.
Action Required
Starting March 2026: When receiving medical record requests from Advantmed for RADV audits, respond as quickly as possible with complete medical records from the requested audit year. Medical records staff should prioritize these requests due to time-sensitive nature. No patient authorization is required as this falls under healthcare operations under HIPAA. Contact BCBSTX RADV department with questions.
Plan Types
Medicare Advantage
States
TX
Specialties
all-specialties