ExchangeAdministrativeMedium impact
You May Receive Records Requests to Comply with Risk Adjustment Data Validation Audit
BCBS Oklahoma·OK·General
Effective date
Jun 1, 2026
We identified it
Jun 18, 2026
Summary
Healthcare providers may receive medical records requests from CMS to comply with HHS Risk Adjustment Data Validation Audits starting in June. Providers are contractually required to respond by the deadline specified in the request to validate diagnosis codes used for ACA risk adjustment calculations.
Action Required
When audit letters are received: Billing and medical records teams must respond to CMS medical records requests by the deadline listed on each request. Prepare to provide all medical records tied to 2025 for sampled members enrolled in ACA-compliant individual and small group plans. Contact the insurer's RADV department for questions regarding individual and family plans.