New Jersey Medicaid: Prepare for medical record reviews

Immediately: All clinical providers and medical staff must review the 10 frequently missed audit items and ensure compliance in all patient medical records: (1) primary language documentation for all ages, (2) advance directive records for adults and emancipated minors, (3) dental education/referral documentation for adults and children age 1+, (4) alcohol/substance abuse screening documentation for age 11+, (5) tobacco/nicotine screening documentation for age 11+, (6) sexual activity/family planning screening documentation for age 11+, (7) immunization documentation for all ages, (8) prenatal care and birth/operations documentation for ages birth-18, and (9) verbal lead risk assessment for ages 6 months-6 years. Providers should update EMR templates and encounter forms to ensure all required documentation fields are captured during patient visits. Medical records staff must establish a quality control process to verify completeness and legibility before records are submitted for audit. When audit selection notices are received, compile and organize medical records according to UnitedHealthcare requirements. Failure to provide complete documentation during audits may result in corrective action plans, potential contract penalties, and reputational damage. Designate a staff member to monitor the UnitedHealthcare Provider Portal for audit notifications and coordinate record compilation.