EmblemHealth and ConnectiCare are required to respond to the annual HHS-Risk Adjustment Data Validation Audit (HHS-RADV) of its Affordable Care Act (ACA) exchange members.
Beginning in July 2022, our contracted Initial Validation Auditor (IVA), Cognisight, Inc., will contact those practitioners who provided care to EmblemHealth and ConnectiCare members that are part of the HHS-RADV sample. Cognisight will request the submission of the complete medical record for specific patients and dates of service between Jan. 1, 2021 and Dec. 31, 2021.
NOTE: A member authorization is not required to release the medical records based on the business associate agreement between EmblemHealth, ConnectiCare, and Cognisight.
We ask that you respond promptly when contacted by Cognisight 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 they can respond promptly to Cognisight’s requests.