Or. Admin. R. 410-120-1360 - Requirements for Financial, Clinical and Other Records

Medicaid participating providers must maintain financial and clinical records.  The records must be well documented and be complete before requesting payment from the Division of Medical Assistance Programs.  Financial records must include the services provided and the amount billed.  Clinical records must include the patient’s diagnosis and medical need for services.  The provider must also ensure there are policies in place to protect the confidentiality of the medical record information.  Medicaid clinical records must be maintained for at least seven years and financial records must be retained for five years.  Medicaid providers must also furnish documents for inspection or copying if requested by the Department of Human Services, Medicaid Fraud Unit, the Oregon Secretary of State, or the Department of Health and Human Services.  Access to patient records does not require authorization if it is for billing purposes, utilization review, quality or medical appropriateness of treatment, payment purposes, or for an investigation by the Medicaid Fraud Unit.