Medical Record Requests for the HHS Risk Adjustment Data Validation Program (HHS-RADV)

On behalf of the Secretary of the Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) is responsible for annually validating the accuracy of risk adjustment data submitted by a health insurance company with risk adjustment covered plans in the individual and small group health insurance markets through the validation of medical records for States where HHS operates the risk adjustment program. This process is known as the HHS-operated Risk Adjustment Data Validation (HHS-RADV) program.

The current HHS-RADV audit pertains to services provided during the 2020 benefit year. Because the 2020 benefit year HHS-RADV medical record review process begins in May 2021, your immediate attention to these requests is appreciated.

Click here to learn more.