Annual commercial plan federal audit

As a UnitedHealthcare commercial plan network health care professional, you may be randomly selected to provide members’ medical records for the Department of Health and Human Services (HHS) annual Risk Adjustment Data Validation (RADV) Program audit. We are asking various health care professionals to provide the supporting medical documentation of our members’ medical services for review.

What’s needed from you

You’ll need to provide medical records of chosen members selected within a specific 2022 service period. Since only a select number of enrollees will be picked for the audit, not all health care professionals will receive this request. If you are contacted, you’ll be asked to provide the following documentation:

Note: UnitedHealthcare members covered under an individual and/or small group plan will also be included in this audit.

Ciox Health is our vendor for medical records requests

We use Ciox Health to conduct requests for medical records for this HHS-RADV audit. You’ll receive a username and password in the medical record request packet sent to you. Go to cioxlink.com/loginopen_in_new and watch the short video to learn how to securely submit electronic medical records quickly and easily.

Note: Please do not send medical records to CMS or its contractors.

Submitting documentation

When providing medical records, include only the minimum HIPAA necessary documentation.

Also, please be sure the medical records clearly document the following:

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

Additionally, all medical records must be dated and verified with your credentials. 

Questions?

For additional questions and information, call Provider Services at 877-842-3210 8 a.m.–6 p.m. CT, Monday–Friday.

Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare Benefits Plan of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of the Mid-Atlantic, Inc., MAMSI Life and Health Insurance Company, UnitedHealthcare of New York, Inc., UnitedHealthcare Insurance Company of New York, UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Pennsylvania, Inc., UnitedHealthcare of Texas, Inc., UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc., UnitedHealthcare of Washington, Inc., Optimum Choice, Inc., Oxford Health Insurance, Inc., Oxford Health Plans (NJ), Oxford Health Plans (CT), Inc., All Savers Insurance Company, Tufts Health Freedom Insurance Company or other affiliates. Administrative services provided by OptumHealth Care Solutions, LLC, OptumRx, Oxford Health Plans LLC, United HealthCare Services, Inc., Tufts Health Freedom Insurance Company or other affiliates. Behavioral health products provided by U.S. Behavioral Health Plan, California (USBHPC), United Behavioral Health (UBH), or its affiliates.

PCA-1-23-00879-E&I-News_04042023