The request is specific, not general
A RADV request names particular members, particular dates of service, and particular diagnosis codes, and asks for the medical record documentation that supports each one. It does not ask whether the organization generally does good work. It asks for evidence tied to a specific decision, and an organization that cannot locate that evidence quickly is in a weaker position regardless of how sound the original decision was.
The clock starts before the organization is ready
The timeline for responding to a RADV request is fixed once it arrives, and it does not wait for records to be tracked down across systems that were never designed to be queried together. Organizations that can only assemble a response by searching manually across several sources are working against a deadline that was never built around their process.
Being ready means the record already exists in a usable form
The organizations that respond well to a RADV request are usually not doing anything special at the moment the request arrives. They already have the documentation connected to the original decision in a form that can be retrieved quickly, because that connection was built when the decision was made, not reconstructed under deadline afterward.
How Embel Assist helps healthcare organizations establish the evidence behind payments, providers, and program integrity.
Read the challenge in full: Proof, Integrity and RADV