Delaware First 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 Delaware First Health to review the quality and appropriateness of the services rendered. Delaware First Health will conduct random medical record audits as part of its QI program to monitor compliance with the medical record documentation standards. For more detailed information about standards, please see the MRR section of the Delaware First Health Provider Manual.
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. Delaware First Health will provide written notice prior to conducting a medical record review.