New Jersey Medicaid: Prepare for random medical record audits

UnitedHealthcare Community Plan of New Jersey will conduct annual reviews of network care providers’ medical records. These medical record audits are contractually required to help ensure quality member care. Our clinical quality team is actively reviewing select members’ records to help ensure compliance with industry standards outlined in Chapter 13 of the New Jersey care provider manual.

What this means for you

If you’re selected for review, please ensure your medical records are complete, orderly and legible. Once the review is completed, you’ll receive review results in the mail within a few weeks. Repeated non-compliance could result in a corrective action plan.

The following list includes frequently missed audit items. Please ensure these items are provided during the review.

• Primary language documentation (all ages)
• Advance directive records (adults and emancipated minors)
• Dental education/referral documentation (for adults and any child age 1 and older)
• Alcohol/substance abuse screening documentation (age 11 and up)
• Tobacco/nicotine screening documentation (age 11 and up)
• Sexual activity/family planning screening documentation (age 11 and up)
• Immunization documentation (all ages)
• Prenatal care, birth and operations of childhood (age birth to 18)
• Verbal lead risk assessment (age 6 months–6 years)