Cognisight beginning CMS risk adjustment validation soon

Once a year (usually early summer), approximately 400 members of ACA individual and small group plans have their records audited for accuracy of risk adjustment. We have contracted with a vendor, Cognisight, to assist us with the CMS-mandated risk adjustment data validation (RADV) program.

This risk-adjustment validation is different from that conducted by Change Healthcare/Altegra because for this activity, CMS requires Priority Health to validate charts that are already risk-adjusted. Therefore, Cognisight may be contacting you on our behalf.

Providers and members affected

We will not know the specific providers or members we need medical records for until CMS provides us with the sample list, which we expect sometime the third week of June.