24-137 Prepare to Retrieve Medical Records for DHCS Encounter Data Validation

Date: 02/06/24

How to be ready if you’re selected

As a reminder, effective January 1, 2024, your provider contract with Health Net Community Solutions, Inc. (Health Net) replaced your California Health & Wellness Plan (CHWP) contract. As a result of this transition, we want to ensure you are aware of the information below, which affects physicians and other providers who served CHWP members in 2022. Starting in February, Datafied™ will contact selected providers to schedule medical record 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.

Plan providers are required to provide medical records selected for review on the list received from Datafied.

If Datafied contacts you, 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 date(s) of service (DOS) within the study time frame, Jan. 1-Dec. 31, 2022.
• 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.).
• Records for an additional DOS closest to the specific requested DOS. For the additional DOS, please choose a DOS that is not for lab, durable medical equipment (DME) or inpatient services. Please do not submit documentation if there is no additional DOS other than lab, DME or inpatient services.
• A copy of the completed tracking sheet. If you do not submit medical record documentation, you must select a non-submission reason.

Additional information

Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact Community Health Plan of Imperial Valley at 833-236-4141.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.

This information applies to Medi-Cal in Imperial county.