Medicare AdvantageAdministrativeHigh impact
CMS RADV Audit For Medicare Advantage Members
Florida Blue·FL·Medical Policy
Effective date
Jun 1, 2026
We identified it
Jun 30, 2026
Summary
CMS is conducting a Risk Adjustment Data Validation (RADV) audit for Florida Blue Medicare Advantage members with 2020 dates of service. Providers may receive medical records requests between June-November 2026 and must submit requested records within 10 business days (maximum 45 days from request date) to support CMS's validation of diagnosis coding accuracy for Medicare Advantage risk adjustment payments.
Action Required
By June 2026 (upon receipt of request letter): Establish a process to track and prioritize RADV audit medical records requests from Florida Blue. Within 10 business days of receiving the records request letter: Billing/medical records team must compile and submit all requested medical records including progress notes for listed BlueMedicare HMO and PPO members with 2020 dates of service. Set internal deadline of 30 days from request receipt to allow 15-day buffer before the 45-day CMS deadline. Designate staff to monitor the RPMChartProcurement@FloridaBlue.com mailbox for incoming audit requests. Document all submissions with dates and member identifiers to track compliance. Failure to submit complete records by the 45-day deadline may result in payment recoupment or contract penalties for non-compliance with CMS audit requirements.