Medicare contract level risk adjustment data validation (RADV) audit to begin this month


Cognisight, LLC, may contact you through June to retrieve and review medical records of patients with ConnectiCare Medicare Advantage who were seen at your office in 2014.

The Centers for Medicare & Medicaid Services (CMS) has asked ConnectiCare to undergo a contract level risk adjustment data validation (RADV) audit on a small sample of members enrolled in Medicare Advantage plan. To verify the accuracy of diagnosis date submitted, this audit requires us to submit supporting medical records on a limited population of members covered by the audit. The dates of service requested will be between Jan. 1, 2014 and Dec. 31, 2014.

Cognisight will retrieve, review and submit medical records for the members in the audit population. Cognisight will contact your offices to coordinate the chart retrieval method and set the date when the records are needed.

Please respond to Cognisight’s requests for records promptly. This is a federally-mandated audit. Notice of the need for these reviews and your required compliance are included in your contract with ConnectiCare.

As our partner and “business associate,” as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Cognisight is fully HIPAA-compliant and required to protect, preserve and maintain the confidentiality of any protected health information (PHI) obtained from clinical records provided by medical practices.

We appreciate your help. If you have questions, please call our provider services department at  1-877-224-8230.