July 1, 2026

Throughout the year, you may receive medical records requests from our Quality Management Department. These requests are mandated and part of routine reviews. 

Throughout the year, you may receive medical records requests from our Quality Management Department. These requests are mandated and part of routine reviews. These medical record reviews are exempt from charge and do not require consent from our members. This is outlined in your provider contract. Please note that these requests are time sensitive. Some requests require a direct response letter from the provider, such as those that entail a member complaint or inquiry from one of our Medical Directors.

Some of the reasons that our Quality and Clinical review team will collect medical records may include (but are not limited to):

• TARS-HEDIS measures
• Pay for Performance (P4P) – help us help you
• Medical Record Review Audit
• Complaints/Grievances (response letter required)
• Quality of Care (QOC) Referrals
• Quality of Care Inquiry (response letter required)

To reduce the burden on your staff, please consider granting remote access to your electronic medical record (EMR) account to a designated Jefferson Health Plans staff member. We will communicate the purpose and timeline for each medical record request and/or follow your established protocol in addition to our privacy and security measures.

For more information on the types of Quality requests, as well as contact information for our Quality Management Team, please visit the Medical Records Requests section of our Quality and Population Health webpage.