RADV Audit for 2020 Underway

Our vendor, Datafied, is contacting health care providers who are part of the RADV audit sample. Datafied is asking providers to submit the complete medical record for specific patients for dates of service between Jan. 1, 2019, and Dec. 31, 2019. Providers who have not yet supplied the requested records to Datafied will be contacted by a representative to secure the charts. 

Please note that member authorization is not required to release the medical records based on the business associate agreement between EmblemHealth and Datafied.

When you receive a request from Datafied, we ask that you respond promptly and submit the required documentation using one of the secure delivery methods detailed in the communication materials.

Providers who work with a vendor to manage medical records are encouraged to notify their service suppliers now so that responses to Datafied’s requests can be issued timely.

Centers for Medicare & Medicaid Services (CMS) recently issued notice to EmblemHealth that five additional contract-level RADV audits will be conducted between May 2026 and August 2027.

Each audit may require you to submit additional medical records as described above. EmblemHealth will continue to alert you through this type of communication when the next audit is underway.