Provide Records To Support Risk Adjustment Data Validation Audits for Medicare Advantage

May 19, 2026

Medicare Advantage providers may receive medical record requests from Blue Cross and Blue Shield of New Mexico and our vendor Advantmed for Centers for Medicare & Medicaid Services’ Risk Adjustment Data Validation audits. The audits will follow this CMS schedule: 

How you can help: If you have patients included in the audit, you’ll receive a letter from Advantmed with an attached medical records request. It’s important to respond to this request as soon as possible because these audits are time sensitive, and they provide CMS with important information about your patients’ health status. 

Patient authorization isn’t required to release these records, as their collection and review is considered a component of health care operations under the Health Insurance Portability and Accountability Act of 1996.

What the data is used for: The CMS-RADV audit validates that member medical conditions submitted to CMS for the calculation of risk adjustment payments are accurate. The audit is performed on a sample of members enrolled in Medicare Advantage plans. We are requesting all records from the sampled year. 

If you have questions, contact our RADV department.

Advantmed, LLC is an independent company that has contracted with BCBSNM to request medical records. BCBSNM makes no endorsement, representations or warranties regarding third-party vendors and the products and services they offer.