May 6, 2021
As part of the Affordable Care Act (ACA), The Centers for Medicare and Medicaid Services (CMS) conducts an annual audit of health plans. The Department of Health and Human Services (HHS) requires Premera Blue Cross Blue Shield of Alaska to participate in this audit for a sample of members both on and off the Alaska Health Insurance Exchange.
The RADV audit for 2019 date(s) of service was previously postponed by CMS but is now in process. Provider offices may receive a request for medical records from Cognisight or directly from Premera. You only need to take action if you receive a letter requesting medical records in support of the audit.
It’s important to note that the RADV audit for 2020 date(s) of service will remain on the regular CMS schedule and outreach to provider offices requesting medical records will begin early July.