Medicare AdvantageAdministrativeHigh impact
2019 RADV Audit for BCBSRI
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Aug 1, 2025
We identified it
Jun 19, 2026
Summary
BCBSRI has been selected for CMS Risk Adjustment Data Validation (RADV) audits covering 2018-2023 dates of service, with yearly audits planned moving forward. BCBSRI may request medical records for Medicare Advantage patients through contracted vendors Datavant and Sharecare, requiring delivery within two weeks of request.
Action Required
Immediately: Prepare to respond to medical record requests from BCBSRI's contracted vendors (Datavant and Sharecare) within two weeks of receipt. Medical records staff should prioritize BCBSRI Medicare Advantage patient records for RADV audit requests covering 2018-2023 dates of service. Failure to meet the two-week deadline may impact CMS compliance and Medicare Advantage payment accuracy.