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Treatment Record Review

The intent of the treatment record review (TRR) process is to ensure treatment/service records are maintained in a manner that is current, detailed and organized. TRRs are completed in order to monitor adherence to record standards and to assist in improving the overall quality of clinical treatment. TRR tools are based on the applicable HealthChoices regulations governing each level of care, PerformCare policies and procedures, the PerformCare provider manual, current mental health or substance abuse initiatives promoted by Pennsylvania and best practices recognized for mental health and substance abuse services by PerformCare Physician Advisors. These indicators include the adequacy of documentation in:

  • Intake assessment and referrals.
  • Treatment/service plans.
  • Progress notes.
  • Crisis planning/relapse prevention planning.
  • Continuity and coordination of care.
  • Recovery orientation.
  • Discharge planning.
  • Quality indicators such as use of evidence-based practices, use of assessment tools and outcome monitoring.

The TRR process continues to be coordinated with the PerformCare Credentialing cycle. This means that providers will receive an onsite or desk review when a provider is due to be re-credentialed with PerformCare. This process allows for more fully informed credentialing decisions, as the TRR results are presented to the Credentialing Committee for review and provide updated information regarding the quality of clinical treatment reflected in the documentation, as well as other information that may have been obtained through a review of the record sample.

The performance goal for network providers to meet is a minimum benchmark of 80% (total score of review).

Additionally, PerformCare has a performance goal range, as detailed below, that designates when the next review will occur, as well as if additional actions are required following a TRR:

  • 90–100%- Above standard documentation – Very limited opportunities noted for improvement - exceeded minimum benchmark considerably. Provider will be reviewed in accordance with triennial re-credentialing cycle. High achievement will be noted in results letter and noted during presentation at Credentialing meeting, and recognition will be noted within other PerformCare documentation regarding provider.
  • 80–89%- Standard documentation – Minimal opportunities for improvement noted - achieved minimum network-wide benchmark of 80%. No Quality Improvement Plan (QIP) required; provider will continue to be reviewed in accordance with re-credentialing cycle.
  • 70–79%- Below standard documentation – Moderate number of opportunities for improvement noted; QIP is required. Review occurs annually until score is increased to 80% or above.
  • 69% and below- Well below standard documentation – significant number of opportunities for improvement noted. QIP is required and a subsequent review will occur in six months and annually until score is increased to 80% or above.

Providers who score below the benchmark performance goal of 80% are required to submit QIPs within 30 days of the date they receive the results letter. In order for a QIP to be considered completed, the QIP must:

  • Contain an action step for each indicator listed as an opportunity.
  • Delineate the staff person who will assume responsibility for implementation and completion of the QIP.
  • Contain a start date and planned completion date.
  • Clearly indicate evidence of completion (e.g., measureable objectives for each action item).

In addition, PerformCare further analyzes section totals on the TRR tools, even if the total score is above 80%. If a score for a section is below 80%, the provider is asked to provide PerformCare with a brief response regarding how the provider plans to address indicators within the section that scored below 80%. The brief responses on the individual sections scoring below 80% are due within 30 days from the date that a provider receives the results letter.

PerformCare will continue to meet individually with providers to review tools, at the provider's request, and will also collect any feedback that providers may have during exit interviews. If you are a provider interested in meeting individually to review the TRR tools, please contact your assigned account executive.