Home State 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 Home State to review the quality and appropriateness of the services rendered. Home State will conduct random medical record audits as part of its QI program to monitor compliance with the medical record documentation standards linked below.
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. Home State will provide written notice prior to conducting a medical record review.