New Jersey: Be prepared for random medical record reviews
UnitedHealthcare Community Plan of New Jersey will be conducting annual reviews of network care providers’ medical records. These medical record audits are contractually required to help ensure quality member care. Our clinical quality team is now actively reviewing select members’ records to help ensure compliance with industry standards outlined in Chapter 12 of your care provider manual.
What’s required
The following list includes frequently missed audit items. Please ensure that these items are provided.
- Primary language documentation (all ages)
- Advance directive records (adults and emancipated minors)
- Dental education/referral documentation (for adults and any child ages 1 and older)
- Alcohol/substance abuse screening documentation (ages 11 and up)
- Tobacco/nicotine screening documentation (age 11 and up)
- Sexual activity/family planning screening documentation (age 11 and up)
- Immunization documentation (all ages)
- Prenatal care, birth and operations of childhood (age birth to 18)
- Verbal lead risk assessment (ages 6 mo.–6 yrs.)
What this means for you
If you are selected for this review, please ensure that your medical records are complete, orderly and legible. Once completed, you’ll receive review results in the mail within a few weeks.
Note: Repeated non-compliance could result in a corrective action plan.
Questions?
For questions or if you would like compliance assistance, please call the Quality Management Department at 763-361-1561. You can also connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.
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