New Claims System Update

10.1 Requirements Overview

Provider Manual
heartbeat_stet

10 Medical Records

10.1 Requirements Overview

IntegraNet providers must maintain permanent medical records that are:

  • Current, detailed and organized; permit effective, confidential        patient care; and allow quality reviews
  • In conformity with good professional medical practice and        appropriate health management
  • Located at the primary care site for every member
  • Kept in accordance with federal and state standards as described       in this manual
  • Retained for 10 years from the final date of the contract or from       the date of completion of any audit
  • Accessible upon request to Health Plan, IntegraNet, any state       agency and the federal government

    • IntegraNet will:

  • Systematically review medical records to ensure compliance with standards. The health plan’s MAC oversees and       directs Health Plans in formalizing, adopting and monitoring guidelines
  • Institute actions for improvement when standards are not met
  • Maintain a record keeping system that is designed to collect all pertinent medical management information for       each member
  • Make information readily available to appropriate health professionals and appropriate state agencies
  • Use nationally recognized standards of care and work with providers to develop clinical policies and guidelines of       care for members