Medical Record Reviews Are Being Reinstated
By Kathleen Morris, RN, Quality Improvement Coordinator

You may remember the ARC program, which stood for Ambulatory Record Certification, and was a function performed by the OMA on behalf of all Oregon Health Plans. Record review was required for health plan certification by NCQA.

When that requirement was dropped, ARC was disbanded. However, record review is still required by DMAP (Oregon's Division of Medical Assistance Programs) and CMS (Centers for Medicare & Medicaid Services). Consequently, as of July 2007, we started an in-house process at CareOregon that ties the regulatory required record review process to re-credentialing. We will ask you to send us copies of three selected charts.

We are appreciative of the extra work required on your part, but hope we have implemented a relatively painless process. We will reimburse copying costs.

If you want the details, feel free to contact us. We will be happy to provide a copy of the audit tool and/or relevant credentialing policy and procedures.