Provider Medical Record Standards have been adopted by the Highmark Health Options Quality Improvement and Utilization Management (QI/UM) Committee. The importance of having standards is to confirm that health care providers are:
The Provider Medical Record Audit is 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.