PA Health & Wellness providers must keep accurate and complete medical records. Such records will enable providers to render the highest quality healthcare service to participants. They will also enable PA Health & Wellness to review the quality and appropriateness of the services rendered. PA Health & Wellness 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 participants, including over/under utilization of specialists, as well as the outcome of such services also may be assessed during a medical record audit. PA Health & Wellness will provide written notice prior to conducting a medical record review.