Providers who delivered care to EmblemHealth and ConnectiCare Affordable Care Act (ACA) exchange members are required to respond to the annual Department of Health & Human Services Risk Adjustment Data Validation Audit (HHS-RADV).
Beginning this summer, Cognisight, Inc., our contracted Initial Validation Auditor (IVA), will contact providers who cared for EmblemHealth and ConnectiCare members who are part of the HHS-RADV sample. Cognisight will ask providers to submit the complete medical record for specific patients for dates of service between Jan. 1, 2022, and Dec. 31, 2022.
When you receive a request from Cognisight, we ask that you respond promptly and submit the required documentation using a secure delivery method. Cognisight will provide detailed submission instructions in its communication materials.
Providers who work with a vendor to manage medical records are encouraged to notify their service suppliers now so that responses to Cognisight’s requests can be issued in a timely manner.
NOTE: A member authorization is not required to release the medical records based on the business associate agreement between EmblemHealth/ConnectiCare and Cognisight.
JP 62308 06/2023
