Annual federal audit of commercial plans

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

As part of a routine federal Health and Human Services Risk Adjustment Data Validation (HHS-RADV) audit, we may ask some health care providers to submit medical records. These requests will included select UnitedHealthcare commercial members covered under individual and/or small group plans. Not all providers will receive a request.

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 2025. 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

If selected, you might be asked to submit some or all of the following documents and forms:

Submitting medical records

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

Make sure the records clearly show:

• Member name, date of birth and gender
• Date(s) of service
• Documented diagnoses

After reviewing all medical records, you must ensure they are dated and signed by the provider with their 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 or receive duplicate or unclear requests, call Datavant at 877-445-9293.