Be prepared: Annual federal audit of commercial plans launching soon

Starting July 2026: All providers who receive an HHS-RADV audit request from Datavant must be prepared to submit medical records. Establish a process to: (1) Identify and locate medical records for audited members within the required timeframe, (2) Ensure records include member name, date of birth, gender, dates of service, documented diagnoses, provider signature, and credentials, (3) Submit only minimum necessary HIPAA-required information, (4) Track submissions and maintain documentation of what was submitted. Assign responsibility to medical records/billing staff or EMR administrator. If you receive duplicate requests or have submission issues, contact Datavant at 877-445-9293. Failure to respond to audit requests or submit incomplete records may result in claim recoupment or audit findings. Not all providers will be selected, but those contacted must comply with federal audit requirements.