July 01, 2024

Annual federal audit of commercial plans

You may be contacted as part of the Risk Adjustment Data Validation (RADV) audit program

In compliance with the Health and Human Services-Risk Adjustment Data Validation (HHS-RADV) program, we are required to provide supporting medical documentation to support the review of the medical encounter(s) for UnitedHealthcare members. UnitedHealthcare members who are covered under individual and/or small group plans are included in this audit.

Beginning in July, we will be reaching out to randomly selected providers to gather the medical records for members selected within a specific range of 2023 service date(s). Since only a select number of members are randomly selected for the audit, not all providers will receive this request.

What is being requested from you?

UnitedHealthcare commercial plan network health care professionals may be randomly selected to provide members’ medical records for audit. If you are contacted to provide documentation, you may be asked to provide some or all of the following information and forms:

  • Anesthesiology records
  • 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

Submitting documentation

When providing medical records, include only the minimum HIPAA necessary documentation.

Also, please be sure the medical records clearly document the following:

  • The patient’s name, date of birth and gender
  • The patient’s service date(s)
  • The patient’s condition/diagnosis and treatment

Additionally, all medical records must be dated and verified with your credentials.

Datavant is our vendor for medical records requests

We will continue to use Datavant (formerly named as CIOX Health) to conduct the request for medical records to support the HHS-RADV audit. Learn how to securely submit medical records via this video tutorial. You can reach Datavant at 877-445-9293.

Questions? We're here to help.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.


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