Risk Adjustment Data Validation Medical Records Requests
Issue: #409 Jul2019
Blue Cross Blue Shield of North Dakota (BCBSND) is required by The Department of Health and Human Services (HHS) to participate in an annual Initial Validation Audit (IVA) for a sample of our members both on and off the Health Insurance Marketplace. This audit is not specific to you or your practice.
Cognisight is the IVA vendor selected to gather medical records on behalf of BCBSND. You can expect to receive faxed medical record requests beginning in July 2019. Since this is a government mandated audit, it is your obligation to provide medical records or obtain records from your vendor and submit the requested medical records with no charge.
All Blue Cross and Blue Shield Plans are required to use Inovalon to retrieve medical records from providers in other plan’s service areas. You can also expect to receive medical record requests from Inovalon on behalf of other Blue Plans, whose members are your patients.