ACA HHS-Operated Risk Adjustment Data Validation (HHS-RADV)

Under the Affordable Care Act, the Department of Health and Human Services (HHS) conducts an annual data validation process to ensure the integrity and quality of data provided by medical insurers is supported in the patient’s medical record. As a result, Blue Cross and Blue Shield of Alabama has partnered with CogniSight to assist in gathering and reviewing all necessary medical records. CogniSight has been contracted by Blue Cross as a business associate covered by the Health Insurance Portability and Accountability Act (HIPAA). CogniSight is ethically and legally bound to protect the confidentiality of any protected health information it gathers from clinical medical records provided by any of our physicians, hospitals or medical practices. If any of your patients are selected as part of the data validation sample, you will receive a letter from Blue Cross along with information from CogniSight detailing the requested documents. After the letter is received, a member of CogniSight’s staff will contact you to discuss the next steps in the process.