Medical Record Requests: Upcoming CMS Risk Adjustment Data Validation Audits (June 2026)
Posted on May 29, 2026
Attention: Health New England is providing advance notice to Providers
The Centers for Medicare & Medicaid Services (CMS) recently announced its Risk Adjustment Data Validation (RADV) audits. These audits are conducted by CMS to validate diagnoses submitted by providers to Medicare Advantage plans, and ultimately to CMS for payment. Their purpose is to ensure that payment accurately reflects the documented health status of our members.
The key to Health New England’s success in responding to these RADV audits is procurement of medical records. Given the anticipated cadence of audits, we anticipate record requests to our providers related to RADV audits will be ongoing for at least the next year.
Over the next several months, if any of your patients are included in a RADV sample, we will reach out to request specific medical records with specific details on delivery. We respectfully ask that you return the requested records within 15 days of our outreach. These audits potentially carry significant financial consequences, and timely responses are critical.
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