Clinical Practice Guidelines can be used to help direct care based on best available evidence based practices in order to reduce inappropriate variation in practice and provide best care for members.
Medical Record Review (MRR) Standards have been adopted by the Highmark Health Options Quality Improvement and Utilization Management (QI/UM) Committee. The importance of having standards is to verify that providers are:
The following MRR Standards have been developed:
Medical record reviews are conducted annually on a sample of PCPs, Specialists, and Behavioral Health Providers. Medical records for this review are obtained directly from the provider and may be reviewed at the provider’s on-site location or sent to Highmark Health Options for a desktop review.
The State of Delaware requires providers to report certain diseases, infections, conditions, and outbreaks such as, but not limited to, chicken pox, lead poisoning, Lyme disease, and mumps. A full listing of notifiable diseases is available on the Delaware Division of Public Health website. This listing provides instructions for reporting and includes those conditions identified as rapidly reportable to DHSS.
 Delaware Administrative Code, 16 DE Admin Code 4202 Control of Communicable and Other Disease Conditions, Section 2.0