See the Results of Our 2024 Medical Record Review

June 18, 2025

We annually perform a medical record review audit to assess whether providers that participate with us for Medicaid meet the minimum New Mexico Administrative Code requirements and our medical records documentation standards. Documentation standards and record reviews help to ensure quality of care for our members.

Review methods: Each year, we determine the number of providers and medical records needed to achieve a statistically valid sample. This year we randomly selected a mix of 15 primary care and obstetrics and gynecology providers to submit medical records. These providers needed at least 10 member visits between September 2023 and August 2024, and those members had to have two or more visits with the provider within that time frame. As part of the review:

• Providers are provided a copy of NMAC and our standards to review as part of the initial medical record request.
• We evaluate all received charts against NMAC medical record standards. Providers must achieve a goal of 80% or better to pass the audit.
• We also evaluate records against our medical record standards, but this evaluation isn’t part of the calculated score.
• Our Quality Improvement Committee − consisting of our medical directors and other participants, as well as external practitioners – reviews the results and provides feedback.

If a provider doesn’t meet the established threshold of 80%, we may require them to submit a plan to correct the identified deficiencies to the Quality Improvement Department. Per policy, providers who fail the medical record audit will be included in the next review.

Results: Of the 15 providers who were selected, 14 passed the audit with a score of 80% or higher. One provider failed to supply requested records.

Learn more about our medical records documentation standards. If you have any questions, contact the Quality Improvement Department at 1-855-699-0042 or qualityinquires@bcbsnm.com.