Annual Risk Adjustment Data Validation (RADV) Audits

As part of the Affordable Care Act, The Centers for Medicare and Medicaid Services conducts an annual Risk Adjustment Data Validation (RADV) audit of health plans. The Department of Health and Human Services requires Premera Blue Cross Blue Shield of Alaska to participate in this audit for a sample of members who purchased plans on and off the Alaska Health Insurance Exchange.

The RADV audit for 2025 date(s) of service is now in process:

• Provider offices may receive a request for medical records from Datavant or directly from Premera.
• Premera will only reimburse copy cost fees for the allowed amount within your contract. You can validate allowed copy cost fees in sections 5.01 and 5.02 of your contract agreement with Premera.
• If you don’t receive a letter, you don’t need to do anything.