22-150 Prepare to Retrieve Medical Records for DHCS Encounter Data Validation

Date: 02/09/22

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

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 in February, 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).

The DHCS contracts with the Health Services Advisory Group (HSAG) to conduct the EDV study. The EDV study evaluates the completeness and accuracy of encounter data by comparing it with information documented in the medical records.

Health Net providers will be required to provide the medical records selected for review that are on the list they’ll receive from Datafied.

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 notify selected providers in advance of the medical records needed and provide 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 following medical records for review:

• Records for the specific requested dates of service (DOS) and the nearest DOS within the study time frame, Jan. 1-Dec. 31, 2020.
• Records for an additional DOS closest to the specific requested DOS. For the additional DOS, please choose a DOS that is not for laboratory, durable medical equipment (DME), or inpatient services. Please do not submit documentation if there is no additional DOS other than laboratory, DME, or inpatient services.
• Documents that support services rendered by a provider (e.g., chart/visit progress notes showing DOS, service descriptions and who rendered the services). Include a patient registration/demographic page to help identify 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 Provider Services Center within 60 days, by phone or through the Health Net provider website.