Arizona Complete Health providers must keep accurate and complete medical records. Such records will enable providers to render the highest quality healthcare service to members. They will also enable Arizona Complete Health to review the quality and appropriateness of the services rendered. Arizona Complete Health will conduct random medical record audits as part of its QI program to monitor compliance with the medical record documentation standards.
The coordination of care and services provided to members, including over/under utilization of specialists, as well as the outcome of such services also may be assessed during a medical record audit. Arizona Complete Health will provide written notice prior to conducting a medical record review.
As a reminder, protected health information (PHI) that is used or disclosed for purposes of treatment, payment or health care operations is permitted by HIPAA Privacy Rules (45 CFR 164.506) and does not require consent or authorization from the member/patient. The medical record review staff and/or vendor will have a signed HIPAA compliant Business Associate.