Skip to Content

Information from your health plan about COVID-19 (coronavirus disease)

Learn more

Provider Manual

Medical Record Documentation Standards

Last Updated on February 18, 2021

Security Health Plan’s medical record documentation standards can be found in the Credentialing Program Manual.

To request a paper copy, please call 1-800-548-1224.

For purposes of claims payment, Security Health Plan will not accept an addendum, amendment, correction, or late entry to a medical record dated after a claim denial date.  If an addendum, amendment, correction or late entry to a medical record is legally dated prior to a claim denial, it may be considered for claim payment.  

Incomplete or illegible records can result in denial of payment for services billed to Security Health Plan. In order for a claim for Security Health Plan benefits to be valid, there must be sufficient documentation in the provider's or hospital's records to verify the services performed were "reasonable and necessary" and required the level of care billed prior to the claim being submitted. If there is no or insufficient documentation, then there is no justification for the services or level of care billed. Additionally, if there is insufficient documentation on the claims that have already been adjudicated by Security Health Plan, reimbursement may be considered an overpayment and the funds can be partially or fully recovered.