Medical Records

Provider Type

  • Physicians 
  • Hospitals
  • Ancillary

Participating providers are required to maintain patient medical records in a manner that is current, detailed, complete, and organized. In addition, medical records must reflect all aspects of patient care, be readily available to health care providers and provide data for statistical and quality-of-care analysis.

Standards for the administration of medical records by participating providers are established by Network Providers, LLC (NPLLC). The standards form the basis for the evaluation of medical records by NPLLC.

NPLLC requires that participating providers have a written policy in place that keeps protected health information (PHI) confidential in accordance with the Health Insurance Portability and Accountability Act (HIPAA). The policy must be kept in hard copy or electronic format and must include a functioning mechanism designed to safeguard medical records and information against loss, destruction, tampering, unauthorized access or use, and verbal discussions about patient information to maintain confidentiality.

Provision of Medical Records

Participating providers are required to provide NPLLC with copies of medical records and accounting and administrative books and records, as they pertain to the Provider Participation Agreement (PPA).

The participating provider has financial responsibility to provide copies of medical records so that NPLLC can provide clinical quality management.

Medical records may be required for regulatory reviews by the Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), and Independent Quality Review and Improvement Organization (QIO).