BCBSRI has been selected for a CMS Risk Adjustment Data Validation (RADV) audit for diagnoses captured during 2018 dates of service (DOS). 

CMS also plans to complete RADV audits for 2019 DOS to 2023 DOS by end of January 2026. Moving forward, these RADV audits will be conducted yearly for all plans. To complete the mandated audit validations, we may request the medical records of some of your BCBSRI  member(s). 

RADV is the primary compliance enforcement process used by CMS to ensure premiums paid in Medicare Advantage are accurate.

To ensure the timely gathering of the medical records to meet the CMS deadlines, BCBSRI has contracted with Datavant and Sharecare to retrieve medical records for our Medicare Advantage patients. Due to the strict timeframe imposed in this audit by CMS, we are requesting delivery of these medical records within two weeks of receipt of the request.

We greatly appreciate your prompt cooperation and assistance in providing the necessary medical records. Your efforts are invaluable in helping us ensure that we collectively meet CMS standards and deadlines and maintain the accuracy of our Medicare Advantage payments.

If you have any questions about this notice, please feel free to contact Provider Relations at ProviderRelations@bcbsri.org.