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ON-SITE ASSESSMENTS
On-site facility assessments are performed to assess the quality of care and services provided by
prospective or Participating Providers. Structural elements of quality care and services are evaluated.
On-site evaluations must be performed for all PCPs, OB/GYNs, and high volume Behavioral Health
Providers prior to initial credentialing and re-credentialing.
Components assessed during an on-site evaluation include, but are not limited to, the following:
Office Standards
1. Facility appearance, cleanliness
2. Access to services
3. Administrative/organizational structure
4. Policy and procedure manuals
5. Personnel
6. Confidentiality
7. Fire/safety/emergency
8. Patient care services
9. Ancillary services
10. Medical records organization and maintenance according to CMS and NCQA Medical record
documentation standards.
11. Safety and emergency procedures
12. Member-oriented educational material
13. Advance Directives and Treatment Planning
Medical Record Review
Confidentiality of Records: Participating Providers and Bravo Health agree that all Members’ medical
records shall be treated as confidential to comply with state and federal laws regarding confidentiality of
medical records. However, nothing shall limit timely dissemination of such records to authorized
Providers and consulting physicians, to governmental agencies as required and permitted by law, to
accrediting bodies, to committees of Provider and Plan concerned with the quality of care and utilization
and to Plan for purposes of administration. To the extent permitted by law, Plan shall have the right to
inspect at all reasonable times any medical records maintained by Provider pertaining to Plan’s
Members. Provider agrees to maintain all patient records pertaining to treatment of Members for a
period of ten (10) years.
Medical Records shall not be removed or transferred from Provider except in accordance with general
Provider policies, rules and regulations. Providers agree to furnish Members timely access to their own
records.
Bravo Health may audit a Provider’s medical records, for Bravo Health Members, as a component of
Bravo Health’s quality improvement, credentialing and re-credentialing processes. In accordance with
AMA guidance and NCQA guidelines, medical records must be legible with current details organized
and comprehensive in order to facilitate the assessment of the appropriateness of care rendered.
Documentation audits are performed to assure that Primary Care Physicians maintain a medical record
system that permits prompt retrieval of information. They are also performed to assure that medical
records are legible, contain accurate and comprehensive information and are readily accessible to health
care Providers. Medical record review also provides a mechanism for assessing the appropriateness and
continuity of health care services. Applicable regulations mandate medical record review by Bravo
Health.
