October 2024 Issue
2023 Claim audits coming for Oscar Health Plan members
Over the next few weeks, you may be asked to provide patient records and information for your clients who have Oscar for their health plan coverage.
The request is part of an annual Risk Adjustment Data Validation (RADV) audit that we are required to complete by the U.S. Department of Health and Human Services (HHS). RADV audits review medical records against claim payments to ensure the services billed are supported by the records, and that the claim payment(s) was accurate. Your cooperation with the audit is required by HHS regulations and for compliance with Centers for Medicare and Medicaid Services (CMS) standards.
Here's what you need to know about the audit request
- Who: Outreach will come from Datavant (formerly CIOX) on behalf of Optum Behavioral Health.
- Datavant is an approved partner for this audit. Providing medical records for this purpose is allowed by HIPAA regulations and your participation agreement with us. All information shared during the medical record retrieval and chart review project will be kept in the strictest of confidence, in accordance with all applicable State and Federal laws regarding the confidentiality of patient records, including HIPAA requirements.
- What: The request will outline:
- Which clients (members) have been selected for the audit
- The date(s) of services for calendar year 2023 that are included in the audit (Jan. 1 through Dec. 31, 2023)
- The options for submitting the medical records to Datavant
- Who to contact with questions
- When: Medical records must be given to Datavant no later than Nov. 29, 2024
What medical records you'll need to provide
Please provide the following items for each member requested, as applicable for the service(s) rendered: *
- Demographic/face sheet
- History and physical
- Consult notes
- Progress notes
- Problem list
- Signature log
Questions?
Call Datavant at 1-855-493-8205 Monday through Friday 7 a.m. - 8 p.m. CT, or email chartreview@datavant.com.
*Optum has entered into a Business Associate Agreement (BAA) with Datavant (formerly CIOX) to help retrieve Oscar Health Plan medical records on your behalf. Datavant will minimize any patient care activities and there will be no cost for Oscar members as part of the Issuer Validation Audit (IVA), or Risk Adjustment Data Validation (RADV)