February 17, 2022

Annual audit for Maryland Healthy Kids EPSDT launching soon

Maryland Healthy Kids EPSDT requirements and medical record audit

Every year, UnitedHealthcare Community Plan of Maryland works with health care professionals to complete medical record reviews required by the Maryland Department of Health (MDH). If you’re selected for an audit, we’ll look at your 2021 medical records to help make sure you’re meeting MDH Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements. To meet MDH standards, you must score at least 80% compared to the Maryland Healthy Kids Preventive Health Schedule.

EPSDT audit process

There’s no change in the process for 2022. We’ll contact you soon to ask for documentation for specific patients. We’ll review, audit and score the requested records. Then, our EPSDT quality nurse will share audit results with you.

  • If you pass the audit, we’ll send you the results and no further action will be required
  • If you don’t pass the audit, we’ll let you know you by phone and fax the results
    • We’ll note where you didn’t meet state standards
    • You’ll start the Quality Improvement Plan (QIP) process
    • We’ll do a follow-up audit and request new records for a list of patients

Questions?
Here is a Quick Reference Guide to help improve your chances of being compliant with the state EPSDT requirements.

If you have questions or would like information or EPSDT training, please call Stephanie Harris, UnitedHealthcare EPSDT quality nurse, at 763-330-3522 or email stephanie.m.harris@uhc.com.

PCA-22-00232-C&S-News