The Company’s mission is to build a family of companies that meets the
needs of our policyholders, customers and communities.
The Clinical Credentialing Department supports the Company’s mission by:
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Educating the provider community regarding nationally recognized standards for
confidentiality, medical record documentation, organization and accessibility
and availability of patient appointment accessibility through displays on the Company
website and articles in Company newsletters
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Performing random reviews to assess provider compliance to these standards and
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Overseeing credentialing policies and procedures of delegated entities to
ensure compliance with Company standards
Company medical record standards are based upon the national quality standards of:
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The Centers for Medicare and Medicaid Services
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The Joint Commission
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The National Committee for Quality Assurance
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The Utilization Review Accreditation Commission
The current Company medical record standards can be found by visiting our websites: MedMutual.com,
ConsumersLife.com and CarolinaCarePlan.com.
The Clinical Credentialing Department conducts annual random medical record documentation reviews
on high volume Primary Care and Behavioral Health network providers. This review also assesses provider
to provider communication, continuity and coordination of patient care and patient safety. Providers
receive feedback regarding their compliance with the medical record criteria and documentation
standards along with a request to participate in a survey related to the entire process. Educational
prompts and sample forms are available on our websites.
Medical record documentation review assesses the following:
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Documentation regarding Advance Directive, where applicable
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Presence of a Plan of Care
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Medical record organization and maintenance
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Confidentiality processes and staff training
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Appointment accessibility
The Clinical Credentialing Department also performs medical record reviews for the annual Healthcare
Effectiveness Data and Information Set (HEDIS) audits.
Medical record documentation review results for 2008 showed significant compliance in the following areas:
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Past medical history is documented
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Treatment plan is consistent with the diagnosis
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Confidentiality statement is signed by all office staff
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Medical record is logically organized
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Provider entry is legible
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Medical record is readily available to the provider during business hours
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Medical record is out of public and patient areas
Office Site and Medical Record Documentation Standards
Accessibility Standards