2015 Medical Record Review Project

2015 Medical RecordsIn February 2015, EmblemHealth's Quality Management Department mailed Healthcare Effectiveness Data and Information Set (HEDIS) packets to network providers requesting medical records for specific patients. The documentation identifies what information is needed (e.g., documentation of BMI assessment with height and weight). This audit collects information about EmblemHealth members who were seen in your office and may have received various components of medical and behavioral health care (e.g., number of women receiving a mammogram). The publicly reported HEDIS rates allow consumers and employers to readily compare the performance of health care plans.

Be sure to include the following in each patient's medical record when you receive the request:

  • Patient Information/Registration Sheet/Face Sheet, including date of birth, gender, address, telephone number, next of kin/significant other with telephone number.
  • Each page of the medical record must contain the patient’s name or ID. (If record is two-sided, this information must be on both sides of the page.)
  • If any information (e.g., allergies) is documented on the inside or outside of the file’s front or back cover, include a copy of these pages.

If we do not receive the requested files, we will request the files by telephone or arrange to come to your office to review and photocopy the required medical records. You can avoid disruption of your day-to-day operations by mailing or faxing these records to EmblemHealth as soon as you receive the request.

Contractual Obligation

Please remember that it is your contractual obligation to provide a copy of a Member's medical records, relating to services rendered to Members of the Plan "no later than ten (10) business days after receipt of the written request."

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