The Centers for Medicare & Medicaid Services (CMS) announced on May 21, 2025, a significant expansion of its auditing efforts for Medicare Advantage (MA) plans. Beginning in June, CMS will audit all eligible MA contracts for payment years 2019 through 2023.

CMS will increase its audits from approximately 60 MA plans a year to all eligible MA plans each year (approximately 550 MA plans), including Blue Cross and Blue Shield of North Carolina (Blue Cross NC). CMS will increase auditing from 35 records per health plan per year to 35-200 records per health plan per year based on the size of the health plan. This will help ensure CMS’s audit findings are more reliable and can be appropriately extrapolated as allowed under the Risk Adjustment Data Validation (RADV) Final Rule.

Blue Cross NC will begin requesting medical records for these CMS audits in June 2025. The chart requests for these audits will include provider dates of service from the years 2019 through 2023. Providers that Blue Cross NC is requesting records from will be notified individually with specific details on members, dates of service, and documents to send.