Or. Admin. R. 333-004-0120 - Requirements for Financial, Clinical and Other Records

The Office of Family Health is responsible for analyzing and monitoring the operation of the Family Planning Expansion Program and for auditing and verifying the accuracy and appropriateness of payment, utilization of services, the quality of care and access to care.  The provider must:

• Develop and maintain adequate financial and clinical records;
• Document the service provided, primary diagnosis code, the date on which the service was provide, and the individual who provided the services in every medical records;
• Have policies and procedures to ensure the maintenance of the confidentiality of medical record information;
• Retain clinical records for seven years from the date of service;
• Retain financial and other records for five years from the date of service;
• Provide access to records, including medical charts and financial records without authorization or release from the client for the purposes of:
  • Performing billing review activities;
  • Performing utilization review activities;
  • Reviewing service provided;
  • Facilitating payment authorization and related services;
  • Investigating a client’s fair hearing request;
  • Facilitating investigation by the Oregon Health Authority; or
  • Where review of records is necessary to the operation of the program.
• Comply with the requirements for the Family Planning Expansion Program Eligibility Database, including implementing security measures that protect the confidentiality of the database, preventing any unauthorized access to or disclosure of information from the database;
• Report to the Department of Human Services Information Security Office and to the Office of Family Health any privacy or security incidents that compromise, damage or cause a loss of protection to the database.

Wrongful use or disclosure of the database may cause immediate suspension or revocation of any access granted; the Office of Family Health and the Oregon Health Authority may pursue any other legal remedies provided by the law.