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L.A. Care Health PlanMedicare Advantage · Documentation · Provider Communication · CAMedium impact

Advance Notice - CMS Medicare Advantage Risk Adjustment Data Validation Audit

Effective date
Not stated in the notice
Identified
Oct 6, 2026

Summary

L.A. Care Health Plan has been selected for a CMS Medicare Advantage Risk Adjustment Data Validation (RADV) audit for Payment Year 2024. Providers may receive formal medical record requests from Wakely Consulting Group for encounters from January 1–December 31, 2023, and must submit complete records within 15 days of request receipt, including documentation of member, encounter, diagnoses, assessment, treatment, and provider authentication.

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What to do

Action · 9 steps
01Medical records department and billing team should.
02Prepare to receive formal medical record requests from Wakely Consulting Group in the coming weeks.
03Upon receipt of a request, ensure complete medical records covering January 1–December 31, 2023 are submitted within 15 days of request receipt, per the PPG Service Agreement Exhibit S.1, Section 2.32.
04Include all supporting documentation (history and physical, progress notes, assessment and plan, diagnostic results, discharge summaries, problem lists, medication lists, practitioner signature logs, and provider credentials).
05Submit records using the secure transmission method provided with the formal request—do NOT use unencrypted email due to PHI protection requirements.
06Submit only records responsive to the specific request, avoiding combined files for multiple members or unrelated encounters.
07Do not submit records in response to this advance notice alone.
08Failure to submit timely records may result in audit penalties and recoupment of risk-adjustment payments to L.A.
09Care.

Original notice

Advance Notice - CMS Medicare Advantage Risk Adjustment Data Validation Audit
lacare.org · Always check the source before changing claims.
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