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Medicare Advantage Risk Adjustment Data Validation Audit
Effective date
Sep 1, 2026
Identified
Sep 9, 2026
Summary
CMS is conducting a Risk Adjustment Data Validation (RADV) audit for Florida Blue Medicare Advantage plans covering 2023 service dates (payment year 2024). Providers will receive medical records requests between September 2026 and February 2027 and must submit requested documentation within 10 business days, with a hard deadline of 45 days from the request date.
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What to do
Action · 7 steps
01REQUIREMENTS:
Between September 2026 - February 2027: Billing and clinical teams must monitor for medical records request letters from Florida Blue Medicare Advantage.
02Upon receipt of a request letter:
1. Immediately flag the member list internally and route to the appropriate clinical/medical records department.
032. Locate and compile all requested medical records with progress notes for the identified members' 2023 service dates within 10 business days of receiving the request letter.
043. Submit complete documentation to RPMChartProcurement@FloridaBlue.com per submission instructions in the request letter, ensuring all records are received no later than 45 days from the original request date.
054. Document submission dates and confirmation of receipt for compliance tracking.
065. Assign a staff member to coordinate with clinical staff to ensure timely retrieval and avoid missing the 45-day deadline.
07Consequence: Failure to respond or late submission may result in audit findings, claim recoupments, or penalties for inaccurate diagnosis coding reported for risk adjustment.
Original notice
Medicare Advantage Risk Adjustment Data Validation Audit
files.guidewell.com · Always check the source before changing claims.
Related changes
See all Florida Blue changes →CMS RADV Audit For Medicare Advantage MembersHighEffective Jun 1, 2026 · Medical PolicyCMS RADV Audit, Payment Year 2019: We May Request Medical RecordsMediumEffective Jul 1, 2025 · Claims & BillingCMS to Conduct Risk Adjustment Data Validation Audit for 2019 Service DatesMediumEffective Apr 1, 2026 · Medical PolicyBrowse every Florida Blue change in the policy list