TREATMENT RECORD REVIEWS
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Providers are expected to cooperate with treatment record reviews conducted by VBH-PA as part of health plan operations.  These reviews may occur:

• In response to a specific quality issue or concern that arises.

• To meet account or accreditation agency requirements mandating review on a periodic basis or upon request.

VBH-PA will gain access to treatment records by reviewing them at the provider’s office or by asking the provider to photocopy and send the records.  Prior to treating a member, the provider should obtain the member’s written consent to share their treatment information and records with VBH-PA.  Providers must supply copies of requested records to VBH-PA within five (5) business days.  VBH-PA will treat provider records confidentially as per all applicable Federal and State regulations.

Following the treatment record review, providers will receive a written report that details the findings.  Included in the report will be an Action Plan with specific recommendations that will enable the provider to more fully comply with VBH-PA’s standards for treatment records.

Treatment records are reviewed through application of an objective instrument.  The instrument is continuously under study and revision and VBH-PA reserves the right to alter it as needed.

For the purpose of conducting retrospective case review, clinical files pertaining to VBH-PA members should be maintained for six (6) years.

VBH-PA network providers are required to document service accessibility for the services that are provided.  A network provider must provide face-to-face interventions within one hour for emergencies, within 24 hours for urgent situations, and within seven days for routine appointments and specialty referrals.  VBH-PA collects and analyzes this data to measure performance against these contract standards.  As part of a routine treatment record review, VBH-PA will audit for the following quality management criteria:

• The date of the member’s initial call for an appointment,
• The type of appointment, such as emergency, urgent or routine,
• The date of the first appointment offered,
• The date and the time of the actual evaluation appointment, and
• The documentation of the reason the standard was not met, if applicable.

Diagnostic guidelines and diagnostic adherence indicators for major depression, bipolar disorder, schizophrenia and attention-deficit hyperactivity disorder are posted on our website for reference on the Provider Information Page under the Quality Management section.