Annual federal audit of commercial plans

You may be contacted as part of the Risk Adjustment Data Validation audit program

To comply with the Health and Human Services-Risk Adjustment Data Validation (HHS-RADV) program requirements, we must submit medical records for UnitedHealthcare members' visits. UnitedHealthcare members who are covered under individual and/or small group plans are included in this audit.

Starting in July, we’ll contact a random group of health care providers to request medical records for members who received care during specific dates in 2024. Since only a small number of members are selected for this audit, we will not contact all health care providers.

Information you may need to provide

You may be randomly chosen to provide medical records for an audit. If selected, you might be asked to submit some or all of the following documents and forms:

Anesthesiology records
Demographics sheet
Progress notes/face-to-face office visits
Consultation reports/notes
Discharge summary
Emergency room records
History and physical exam

Medication list
Operative/procedure notes
Prescription for laboratory services
Problem list
Radiology and pathology services
Radiology reports

Submitting medical records

When submitting medical records, include only the minimum necessary information required by HIPAA.

Make sure the records clearly show:

The patient’s name, date of birth and gender
The date(s) of service
The patient’s diagnosis and treatment

Please verify all medical records with a documented review date and credentials.

Medical record management

We will continue working with Datavant (formerly CIOX Health) to request medical records for the HHS-RADV audit. If you need help submitting medical records, call Datavant at 877-445-9293.