Medicare Advantage Risk Adjustment Data Validation Audit

REQUIREMENTS: Between September 2026 - February 2027: Billing and clinical teams must monitor for medical records request letters from Florida Blue Medicare Advantage. Upon receipt of a request letter: 1. Immediately flag the member list internally and route to the appropriate clinical/medical records department. 2. 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. 3. 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. 4. Document submission dates and confirmation of receipt for compliance tracking. 5. Assign a staff member to coordinate with clinical staff to ensure timely retrieval and avoid missing the 45-day deadline. Consequence: Failure to respond or late submission may result in audit findings, claim recoupments, or penalties for inaccurate diagnosis coding reported for risk adjustment.