20-137 Prepare to Retrieve Medical Records for DHCS Encounter Data Submission Validation

Date: 01/30/20

 

This information applies to Physicians & Participating Physician Groups (PPGs).

For Medi-Cal, this information applies to Kern, Los Angeles,  Sacramento, San Diego, San Joaquin, Stanislaus, and Tulare counties.

 

How to be ready if you are selected

Starting February 2020, Datafied™ will contact selected providers to schedule medical records retrievals for the annual Encounter Data Validation (EDV) study. Providers are selected based on a sample of encounter data submitted to the Department of Health Care Services (DHCS).

DHCS contracts with the Health Services Advisory Group (HSAG) to conduct the EDV study. The EDV study evaluates encounter data completeness and accuracy by comparing the encounter data to information documented in the medical records. As such, Health Net* is required to retrieve 411 randomly selected medical records.

If you are contacted by Datafied, you must allow access to members’ medical records to validate encounter data for the selected samples.

What to expect

Datafied will send affected providers advance notice of specific medical records needed and information on:

• How to submit the medical records.
• Types of documents to submit.
• Submission deadline date.

To prepare, please retrieve the information as soon as possible after receiving the notice.

You will need to provide the below for the medical records review:

• Records for the specific requested dates of service (DOS) and the nearest DOS within the study time frame, January 1, 2018, through December 31, 2018.
• Documents that support services rendered by a provider (i.e., chart/visit progress notes showing DOS, service descriptions and who rendered the services). A patient registration/demographic page should be included to assist in identifying the patient (e.g., name, date of birth, etc.).
• A copy of the completed tracking sheet. If medical record documentation is not submitted, a non-submission reason must be selected.

Additional information

If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center at 1-800-675-6110.