Medicare AdvantageAdministrativeMedium impact
Provide Records To Support Risk Adjustment Data Validation Audits for Medicare Advantage
BCBS Illinois·IL·Government Programs
Effective date
Mar 1, 2026
We identified it
Jun 16, 2026
Summary
Medicare Advantage providers must respond promptly to medical record requests from Blue Cross Blue Shield of Illinois and their vendor Advantmed for CMS Risk Adjustment Data Validation audits. These audits validate member medical conditions used for risk adjustment payments and will occur throughout 2026 for various payment years.
Action Required
Starting March 2026: When receiving medical record requests from Advantmed for RADV audits, respond as soon as possible with all requested records from the sampled year. No patient authorization is required as this falls under healthcare operations. Contact the RADV department with questions. Delays in response can impact time-sensitive CMS audits.