April 7, 2025
As part of our quality improvement activities, we conduct an annual review of behavioral health medical records. Our goal is to ensure behavioral health providers are complying with documentation standards for Blue Cross Community Health PlansSM and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM.
Reviews help our members: Medical record documentation standards and reviews are necessary for ensuring quality care, enhancing patient safety and fostering continuity of care. Refer to our evidence-based Clinical Practice Guidelines to learn more about documentation standards.
About the review: We notify providers by mail if they are selected for the review. We review documentation practices through electronic health records. We may request that records be sent to us by fax or mail. Requests may include but aren’t limited to documentation for:
- Confidentiality and security standards
- Consent for treatment and medications
- Demographic information
- Allergies
- Medical and behavioral health history
- Treatment plans
- Discharge plans
Providers are required to comply with quality improvement activities, including the medical record review, as indicated in our provider manuals and in your contract with us.
Patient authorization isn’t required to release these records, as their collection is considered a component of health care operations under the Health Insurance Portability and Accountability Act. We don’t reimburse providers for the cost of medical records.