Sunshine Health providers must keep accurate and complete medical records. Such records will enable providers to render the highest quality healthcare service to members. They will also enable Sunshine Health to review the quality and appropriateness of the services rendered. Sunshine Health will conduct random medical record audits as part of its QI program to monitor compliance with the medical record documentation standards.
The coordination of care and services provided to members, including over/under utilization of specialists, as well as the outcome of such services also may be assessed during a medical record audit. Sunshine Health will provide written notice prior to conducting a medical record review.