July 25, 2025
Medicare Advantage providers may receive medical record requests from Blue Cross and Blue Shield of Illinois and our vendor Advantmed for the Centers for Medicare & Medicaid Services’ Risk Adjustment Data Validation Audit. The CMS-RADV audit began in June 2025.
How you can help: If you have patients included in the audit, you’ll receive a letter from Adventmed with an attached medical records request. It’s important to respond to this request as soon as possible because these audits are time sensitive, and they provide CMS important information about your patient’s health status.
Patient authorization isn’t required to release these records, as their collection and review is considered a component of health care operations under the Health Insurance Portability and Accountability Act of 1996.
What the data is used for: The CMS-RADV audit validates that member medical conditions submitted to CMS for the calculation of risk adjustment payments are accurate. The audit is performed on a sample of members enrolled in Medicare Advantage plans. We may request all records from the sampled year, which includes dates of service from 2018 through 2023.
Be aware − CMS alert on fraud scheme involving phishing requests by fax or email: CMS has issued an alert about a scheme targeting Medicare providers. According to CMS, scammers impersonating CMS are sending requests for medical records, often via fax or email. Learn more.
If you have questions, contact our RADV department.
Advantmed, LLC is an independent company that has contracted with BCBSIL to request medical records. BCBSIL makes no endorsement, representations or warranties regarding third-party vendors and the products and services they offer.