Things to keep in mind when reviewing medical records

When reviewing medical records:

Make sure that the customer’s name is on all records and is correct.

For records that include the customer’s date of birth (DOB), check that it matches the DOB on file. If it does not, determine which one is correct by contacting the provider about the discrepancy. If the provider has the incorrect DOB, but the records are for the customer, add a sentence to the summary stating the provider entered the wrong DOB, but the records are correct. If our records are incorrect contact the Benefits and Eligibility Specialist (BES) and report that the DOB in HEAplus appears to be incorrect.

Review the dates on medical records used to support your scores and decision. The records should be current and relevant to the customer’s condition, typically within the past six months. When older records are relevant, include the explanation in comments. For example, a 50-year-old customer was diagnosed with moderate intellectual disability 35 years ago and that is the most current record of the diagnosis.