Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Horizon BCBS NJMedicare Advantage · Documentation · Medical PolicyMedium impact

RADV Medical Record Requests – What You Need to Know

Effective date
Not stated in the notice
Identified
Oct 3, 2026

Summary

This is an informational policy from Horizon Blue explaining the RADV (Risk Adjustment Data Validation) audit process that CMS conducts annually. The policy clarifies that practices must return 100% of RADV medical record requests within 30 days and outlines how the validation process works through IVA and SVA entities. No billing workflow changes are mandated, but practices should understand their obligations to respond promptly to RADV record requests to avoid audit discrepancies.

Get alerts when payers change rules like this one

We check Horizon BCBS NJ and other payers every day and email you when a change matches your specialty and state.

Get Horizon BCBS NJ alertsPolicy Monitoring is free. No card required.

What to do

Action · 5 steps
01Within 30 days of receiving a RADV medical record request from Horizon Blue: Billing/medical records team must compile and submit all requested medical records for the specified date of service or encounter year.
02Establish a tracking system to monitor RADV requests and ensure 100% submission within the 30-day deadline.
03Verify that diagnosis codes and HCC documentation in submitted records are accurate and supported by clinical documentation.
04Designate a contact person and monitor the RiskAdjustment@HorizonBlue.com email for RADV inquiries.
05Non-compliance or late submissions may result in audit discrepancies, RA transfer adjustments, and potential recoupment of overpayments.

Original notice

RADV Medical Record Requests – What You Need to Know
horizonblue.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Horizon BCBS NJ policies

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account