The Blue Cross and Blue Shield of New Mexico Quality Improvement Department performs an annual Medical Record Review (MRR) audit to assess whether practitioners/providers meet the minimum New Mexico Administrative Code and BCBSNM medical record documentation standard requirements for members under the Blue Cross Community CentennialSM network. Each year BCBSNM determines the number of providers and medical records to achieve a statistically valid sample. Medical records are also evaluated against BCBSNM established medical record standards.
BCBSNM randomly selected 15 primary care/obstetrics/gynecology providers who had at least 10 member encounters between September 2022 and August 2023 where members had at least two visits within the specified timeframe. BCBSNM requested medical records across the 15 provider groups. BCBSNM staff assessed and scored all received charts against NMAC and BCBSNM medical record standards. BCBSNM has an established a goal of 80% or better for records evaluated against the NMAC medical record standards. Scores for records that are evaluated against the BCBSNM-established medical record standards is not part of the calculated provider score.
Should a provider group not meet the established threshold of 80%, BCBSNM may require that provider 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 annual medical record review. Results are presented to the Quality Improvement Committee for consideration and feedback. The QI committee consists of medical directors, external practitioners and BCBSNM management.
Providers are randomly selected and provided a copy of NMAC, and BCBSNM standards to review as part of the initial medical record request. Eleven out of the fifteen providers who provided medical records passed the audit with a score of 80% or higher for NMAC medical record requirements. Three providers failed to provide the requested records after multiple outreach attempts and one provider was removed from the audit.
| Overall Medical Record Review Score | 2023 Results | 2022 Results | 2021 Results | 2020 Results |
| Providers Audited | 15 | 10 | 10 | 15 |
| 80% to 100% | 11 | 8 | 10 | 15 |
| ≤79% | 0 | 0 | 0 | 0 |
| No Response | 3 | 1 | 0 | 5 |
| Ineligible | 1 | 1 | 0 | 0 |
To view, download, or print a sample of the MRR standards, please visit the provider website. BCBSNM would like to extend its appreciation to Providers who provided medical records timely. Should you have any questions or need further information about the medical record audit or any other Quality program activities, please contact the BCBSNM Quality Improvement Department at 1-855-699-0042 or submit your inquiry to qualityinquires@bcbsnm.com.