Medical Records

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Access to Records and Enrollee Health Information

Provider shall permit reasonable access to financial records, medical records, and any other records that relate to their Agreement to authorized representatives of Community Health Plan, Payers, the U.S. Department of Health and Human Services, and Medicaid and Medicare fraud investigators.

Access to such records shall be to the extent permitted by law and as necessary to fulfill the terms of their Agreement.

Provider shall permit audits by Community Health Plan of enrollee's medical records for covered services under their Agreement.

Such inspection, audit, and duplication of records shall be allowed upon reasonable notice during regular business hours.

Providers shall have the right to reasonable access to Community Health Plan claim payment records for the purpose of auditing their claim payment history and claim denial pursuant to WAC 284-43-324.

Provider agrees to maintain all enrollee information in a confidential manner. Enrollee information includes, but is not limited to, medical records, claims, benefits, and other administrative data that is personally identifiable to the enrollee. Any disclosure and use of such information will be made only as permitted by applicable statutes, laws, regulations, and other provisions of their Agreement governing the confidentiality of such information.

Medical Record Documentation Standards

It is a policy of Community Health Plan to protect enrollee safety and the privacy and security of enrollee protected health information. Further, it is Community Health Plan’s policy to require safeguards for all enrollee medical information including the paper medical record and/or electronic health record against loss, defacement, theft, and tampering, and from use by unauthorized individuals.

General Medical Record Policies

A medical record shall be constructed for each Community Health Plan enrollee and maintained by the practitioner while the enrollee is an active patient. If the enrollee becomes an inactive patient, the medical record can be moved to storage. Current Washington State regulations require practitioners to keep the medical record for 10 years after the last visit if the enrollee is 18 years old or above and for 10 years past the age of majority if the enrollee was a child at the time of the last visit.

All medical records, x-ray films, tissue specimens, slides, and photographs are the property of the practitioner.

It is at the discretion of the practitioner’s office to determine the method of filing the medical records; that is, alphabetical order, terminal digit order, or other numbering system. The record itself should be organized to allow easy access to information. For example, the record may be organized with dividers to separate notes and laboratory reports.

All paper based notes, reports, etc. in the medical record must be secured in the enrollee’s folder or electronically attached to the enrollee’s file/record.

An enrollee's medical record should be kept at each practitioner’s office. If the enrollee becomes an inactive patient, the purged medical record may be kept off site. Records should be easily retrievable. All medical records, active and inactive, should be supplied within 30 days of a request. Urgent requests should be met according to the clinical situation.

Compliance with all federal, state, and local regulations pertaining to medical records must be maintained.

All medical record information must be released only by properly trained personnel and only with a HIPAA appropriate patient authorization for release of information form.

Medical Records Audit Document: