Superior HealthPlan providers must keep accurate and complete medical records. Such records will enable providers to render the highest quality healthcare service to members. They will also enable Superior HealthPlan to review the quality and appropriateness of the services rendered. Superior HealthPlan will conduct random medical record audits as part of its QI program to monitor compliance with the medical record documentation standards.
The coordination of care and services provided to members, including over/under utilization of specialists, as well as the outcome of such services also may be assessed during a medical record audit. Superior HealthPlan will provide written notice prior to conducting a medical record review.
Below are some guidelines for Medical Record Maintenance:
- Practitioners are required to maintain all records for members for at least 7 years from the anniversary date of the date of last treatment by the physician.
- If a patient is younger than 18 years of age when last treated by the physician, the medical records of the patient shall be maintained by the physician until the patient reaches 21 years of age, or for 7 years from the date of last treatment, whichever is longer.