Medical Records Requirements. 1. The Health Plan shall ensure maintenance of medical records for each enrollee in accordance with this section and with 42 CFR 456. Medical records shall include the quality, quantity, appropriateness, and timeliness of services performed under this Contract.
2. The Health Plan shall follow the medical record standards set forth below for each enrollee's medical records, as appropriate:
a. Include the enrollee’s identifying information, including name, enrollee identification number, date of birth, sex and legal guardianship (if any);
b. Each record shall be legible and maintained in detail;
c. Include a summary of significant surgical procedures, past and current diagnoses or problems, allergies, untoward reactions to drugs and current medications;
d. All entries shall be dated and signed by the appropriate party;
e. All entries shall indicate the chief complaint or purpose of the visit, the objective, diagnoses, medical findings or impression of the provider;
f. All entries shall indicate studies ordered (e.g., laboratory, x-ray, EKG) and referral reports;
g. All entries shall indicate therapies administered and prescribed;
h. All entries shall include the name and profession of the provider rendering services (e.g., MD, DO, OD), including the signature or initials of the provider;
i. All entries shall include the disposition, recommendations, instructions to the enrollee, evidence of whether there was follow-up and outcome of services;
j. All records shall contain an immunization history;
k. All records shall contain information relating to the enrollee’s use of tobacco products and alcohol/substance abuse; WellCare of Florida, Inc., Medicaid HMO Non-Reform Contract
l. All records shall contain summaries of all emergency services and care and hospital discharges with appropriate medically indicated follow up;
m. Document referral services in enrollees' medical records;
n. Include all services provided. Such services must include, but not necessarily be limited to, family planning services, preventive services and services for the treatment of sexually transmitted diseases;
o. All records shall reflect the primary language spoken by the enrollee and any translation needs of the enrollee;
p. All records shall identify enrollees needing communication assistance in the delivery of health care services;
q. All records shall contain documentation that the enrollee was provided with written information concerning the enrollee’s rights regarding advance direc...
Medical Records Requirements. The Contractor will require network providers/subcontractors to maintain up-to-date medical records at the site where medical services are provided for each member enrolled under this Contract. Each member's record must be legible and maintained in detail consistent with good medical and professional practice, which permits effective internal and external quality review and/or medical audit and facilitates an adequate system of follow-up treatment. The Contractor shall ensure within its own provider network that SCDHHS representatives or designees shall have immediate and complete access to all records pertaining to the health care services provided to members. Medical record requirements are further defined in the Policy and Procedure Guide.
Medical Records Requirements. 1. The Health Plan shall maintain Medical Records for each Enrollee in accordance with this section. Medical Records shall include the Quality, quantity, appropriateness, and timeliness of services performed under this Contract.
a. The Health Plan must include/follow the Medical Record standards set forth below for each Enrollee's Medical Records, as appropriate:
(1) The Enrollee’s identifying information, including name, Enrollee identification number, date of birth, sex and legal guardianship (if any).
(2) Each record must be legible and maintained in detail.
(3) A summary of significant surgical procedures, past and current diagnoses or problems, allergies, untoward reactions to drugs and current medications.
(4) All entries must be dated and signed by the appropriate party.
(5) All entries must indicate the chief complaint or purpose of the visit, the objective, diagnoses, medical findings or impression of the provider.
(6) All entries must indicate studies ordered (e.g., laboratory, x-ray, EKG) and referral reports.
(7) All entries must indicate therapies administered and prescribed.
(8) All entries must include the name and profession of the provider rendering services (e.g., MD, DO, OD), including the signature or initials of the provider.
(9) All entries must include the disposition, recommendations, instructions to the Enrollee, evidence of whether there was follow-up and outcome of services.
(10) All records must contain an immunization history.
(11) All records must contain information relating to the Enrollee’s use of tobacco products and alcohol/substance abuse.
(12) All records must contain summaries of all Emergency Services and Care and Hospital discharges with appropriate medically indicated follow up.
(13) Documentation of referral services in Enrollees' Medical Records.
(14) All services provided by providers. Such services must include, but not necessarily be limited to, family planning services, preventive services and services for the treatment of sexually transmitted diseases.
(15) All records must reflect the primary language spoken by the Enrollee and any translation needs of the Enrollee.
(16) All records must identify Enrollees needing communication assistance in the delivery of health care services.
(17) All records must contain documentation that the Enrollee was provided written information concerning the Enrollee’s rights regarding advance directives (written instructions for living will or power of attorney) and whether or n...
Medical Records Requirements. 1. The Health Plan shall maintain Medical Records for each Enrollee in accordance with this Section. Medical Records shall include the quality, quantity, appropriateness, and timeliness of services performed under this Contract.
Medical Records Requirements. PHP shall require providers to maintain medical records for each participant under this contract in accordance with applicable state and federal law.
3-18-1 Medical Quality Review and Audit FHKC shall conduct an independent medical quality review of PHP at the conclusion of the first twelve months of coverage. The independent auditor's report will include a written review and evaluation of care provided to FHKC participants in Orange, Osceola and Seminole Counties.
Medical Records Requirements. AMERIGROUP shall require providers to maintain medical records for each participant under this Agreement in accordance with applicable state and federal law.
3-19-1 Medical Quality Review and Audit FHKC shall conduct an independent medical quality review of AMERIGROUP during the contract term. The independent auditor's report will include a written review and evaluation of care provided to FHKC participants in the counties covered by the Contract. Additional reviews may also be conducted after completion of the baseline review at the discretion of FHKC. AMERIGROUP agrees to cooperate in all evaluation efforts conducted or authorized by FHKC.
3-19-2 Privacy of Medical Records AMERIGROUP will ensure that all individual medical records will be maintained with confidentiality in accordance with state and federal guidelines. AMERIGROUP agrees to abide by all applicable state and federal laws governing the confidentiality of minors and the privacy of individually identifiable health information. AMERIGROUP'S policies and procedures for handling medical records and protected health information (PHI) shall be compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and shall include provisions for when an enrollee's PHI may be disclosed without consent or authorization.
3-19-3 Requests by Participants for Medical Records AMERIGROUP will ensure that each participant may request and receive a copy of records and information pertaining to that enrollee in a timely manner. Additionally, the participant may request that such records be corrected or supplemented.
Medical Records Requirements. The Contractor will require network Providers/Subcontractors to maintain up-to-date medical records at the site where medical services are provided for each Medicaid MCO Member enrolled under this Contract. Each Medicaid MCO Member's record must be legible and maintained in detail consistent with good medical and professional practice which permits effective internal and external quality review and/or medical audit and facilitates an adequate system of follow-up treatment. The Contractor shall ensure within its own Provider network that the Department’s representatives or designees shall have immediate and complete access to all records pertaining to the health care services provided to Medicaid MCO Members. Medical record requirements are further defined in the MCO Policy and Procedure Guide.
Medical Records Requirements. 2.24.4.1 The CONTRACTOR shall maintain, and shall require contract providers and subcontractors to maintain, medical records in a manner that is current, detailed and organized, and which permits effective and confidential patient care and quality review, administrative, civil and/or criminal investigations and/or prosecutions.
2.24.4.2 The CONTRACTOR shall have medical record keeping policies and practices which are consistent with 42 CFR 456 and current NCQA standards for medical record documentation. The CONTRACTOR shall distribute these policies to practice sites. At a minimum, the policies and procedures shall address:
2.24.4.2.1 Confidentiality of medical records;
2.24.4.2.2 Medical record documentation standards; and
2.24.4.2.3 The medical record keeping system and standards for the availability of medical records. At a minimum the following shall apply:
2.24.4.2.3.1 Medical records shall be maintained or available at the site where covered services are rendered;
2.24.4.2.3.2 Enrollees (for purposes of behavioral health records, enrollee includes an individual who is age sixteen (16) or over) and their legally appointed representatives shall be given access to the enrollees’ medical records, to the extent and in the manner provided by TCA 63-2-101, 63-2-102 and 33-3-104 et seq., and, subject to reasonable charges, (except as provided in Section 2.24.4.2.3.3. below) be given copies thereof upon request;
2.24.4.2.3.3 Provisions for ensuring that, in the event a patient-provider relationship with a TennCare primary care provider ends and the enrollee requests that medical records be sent to a second TennCare provider who will be the enrollee’s primary care provider, the first provider does not charge the enrollee or the second provider for providing the medical records; and
2.24.4.2.3.4 Performance goals to assess the quality of medical record keeping.
2.24.4.2.4 The CONTRACTOR shall maintain and require contract behavioral health providers to maintain medical records in conformity with TCA 33-3-101 et seq. for persons with serious emotional disturbance or mental illness.
2.24.4.2.5 The CONTRACTOR shall maintain and require contract behavioral health providers to maintain medical records of persons whose confidentiality is protected by 42 CFR Part 2 in conformity with that rule or TCA 33-3-103, whichever is more stringent.
Medical Records Requirements. PHP shall require providers to maintain medical records for each participant under this Agreement in accordance with applicable state and federal law.
Medical Records Requirements. The Contractor will require network providers/subcontractors to maintain up-to-date medical records at the site where medical services are provided for each Medicaid MHN program member enrolled under this Contract. Each member's record must be legible and maintained in detail consistent with good medical and professional practice which permits effective internal and external quality review and/or medical audit and facilitates an adequate system of follow-up treatment. The Contractor shall ensure within its own provider network that SCDHHS representatives or its designee shall have immediate and complete access to all records pertaining to the health care services provided to Medicaid MHN program members. Medical record requirements are further defined in the MHN Policy and Procedure Guide.