Medicare AdvantageAdministrativeMedium impact
Provide Records To Support Risk Adjustment Data Validation Audits for Medicare Advantage
BCBS New Mexico·NM·Government Programs
Effective date
Mar 1, 2026
We identified it
Jun 18, 2026
Summary
Blue Cross and Blue Shield of New Mexico will be requesting medical records from Medicare Advantage providers to support CMS Risk Adjustment Data Validation audits starting March 2026. Providers must respond promptly to record requests from vendor Advantmed as these audits are time-sensitive and validate member medical conditions for risk adjustment payments.
Action Required
Starting March 2026: When you receive a letter from Advantmed requesting medical records for Risk Adjustment Data Validation audits, respond as soon as possible with all records from the requested audit year. No patient authorization is required as this is considered healthcare operations under HIPAA. Contact BCBSNM RADV department with questions. Delays in response may impact audit timelines and risk adjustment payment validation.