CMS Medicare Advantage Audits (2019 – 2023)

The Centers for Medicare & Medicaid Services (CMS) will begin mandatory audits for payment years back to 2018. Starting with plan year 2019, CMS will release the next audit in February. Additional audit years will follow about every three weeks.

What This Means

Premera Blue Cross Blue Shield of Alaska will send medical record requests for plan year 2019 first. You’ll receive more requests as CMS releases each through plan year 2023. We may send new requests more than once per audit.

How to Prepare

• Check service dates on each request. You may receive multiple requests for the same member for different plan years from Premera or our vendor, Datavant.
• Choose the retrieval method that works best for you—secure fax, email, website upload, or mail. Email rarequests@premera.com for your website passcode.
• Review section 5.02 Inspection and Audit in your Premera contract. Most contracts require timely record submission without payment for audit requests.
• Note that you don’t need patient consent to send the requested documents.

Your cooperation helps us meet CMS requirements for validating documented member health conditions. Thank you for your timely response.