May 01, 2022

Risk Adjustment Data Validation audit program launching in June for randomly selected enrollees

In compliance with the Health and Human Services (HHS) - Risk Adjustment Data Validation (RADV) program, we are required to provide supporting medical documentation to enable the audit of medical encounter(s) for UnitedHealthcare members.

We will be reaching out to randomly selected providers to gather the medical records for members selected within a specific 2021 service date(s) starting in June. Since only a certain number of enrollees will be randomly selected for the audit, not all providers will receive this request.

Note: Members that are covered under an individual and/or small group plan are included in this audit.

What is being requested from you?
If you are contacted to provide documentation as part of the audit, you may be asked to provide some or all of the following information and forms:

  • Demographics Sheet
  • Progress Notes/Face-to-Face Office Visits
  • Consultation Reports/Notes
  • Discharge Summary
  • Emergency Room Records
  • History and Physical Exam
  • Medication List
  • Operative/Procedure Notes
  • Prescription for Laboratory Services
  • Problem List
  • Radiology and Pathology Services
  • Radiology Reports

When providing documentation, please include only the minimum Health Insurance Portability and Accountability Act (HIPAA) necessary documentation. Also, please ensure that the patient’s name, date of birth, gender, service date(s), and the patient’s condition/diagnosis are clearly documented, supported and demonstrated in the medical records. Finally, ensure that the medical record is dated and authenticated by the provider with their credentials.

Submitting requested documentation
UnitedHealthcare will continue to use CIOX Health to conduct the request for medical records to support the HHS-RADV audit. CIOX Health can be reached at 877-445-9293. See cioxhealth.com for a short video tutorial to learn a new fast, easy and secure way to electronically submit medical records. 

Questions?
Call Provider Services at 866-362-3368.

PCA-22-01086