Annual Risk Adjustment Data Validation Audits

As part of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) conducts an annual audit of health plans. The Department of Health and Human Services (HHS) requires Premera Blue Cross to participate in this audit for a sample of members both on and off the Washington Health Benefit Exchange.

The Risk Adjustment Data Validation (RADV) audit for 2023 date(s) of service is now in process. Provider offices may receive a request for medical records from Cognisight or directly from Premera. If you don’t receive a letter, you don’t need to do anything.