Medicare AdvantageAdministrativeMedium impact
BCBSRI selected for 2019 RADV audit
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Sep 1, 2025
We identified it
Jun 19, 2026
Summary
BCBSRI has been selected for a CMS Risk Adjustment Data Validation (RADV) audit for 2018 diagnoses and will conduct annual audits moving forward. They may request medical records for Medicare Advantage patients through contracted vendors Datavant and Sharecare, requiring providers to submit records within two weeks of request to meet CMS deadlines.
Action Required
Within two weeks of request: Medical records team must respond to BCBSRI medical record requests for Medicare Advantage patients sent through Datavant and Sharecare. Ensure medical records department is aware of the expedited timeline requirement to meet CMS audit deadlines. Contact ProviderRelations@bcbsri.org with questions about record requests.