What key documents are required from managed care organizations during the RADV audit?

The correct answer focuses on the essential documents required from managed care organizations during a Risk Adjustment Data Validation (RADV) audit, specifically medical records and enrollment data. These documents are crucial because they directly support the validation of risk adjustment data reported by the organization to the Centers for Medicare & Medicaid Services (CMS).

Medical records provide detailed clinical information necessary for verifying diagnoses submitted for risk adjustment. The accuracy of the clinical data is critical, as it influences the funding and resources allocated to the organization based on the health needs of its enrolled population. Additionally, enrollment data is vital for confirming the accuracy of member eligibility and demographic information, which also plays a role in the risk adjustment process.

Together, these documents ensure that the data reported is a true reflection of the beneficiary population's health status, ultimately helping to maintain the integrity of the audit process and ensure compliance with federal guidelines. This emphasis on verifying medical necessity and proper documentation helps to identify inconsistencies or misreporting in the organization's submitted risk adjustment data.