CenCal Health’s Medical Record Review (MRR) program continues to evaluate Initial Health Assessments (IHA) and Wellness Visit documentation to confirm that members receive timely and comprehensive preventive care. These reviews are based on evidence-based guidelines from organizations such as the U.S. Preventive Services Task Force (USPSTF), American Academy of Pediatrics (AAP)/Bright Futures, Advisory Committee on Immunization Practices (ACIP), and the American College of Obstetricians and Gynecologists (ACOG).Adhering to these standards helps promote early detection, coordinated care, and improved health outcomes across our community. We appreciate the continued partnership and dedication of our provider network in supporting this work.
Primary Care Provider Responsibilities
Primary Care Providers (PCPs) play a key role in ensuring members receive preventive care on schedule:
- Conduct an Initial Health Assessment (IHA) for each new member within 120 days of assignment.
- Schedule Wellness Visits according to the member’s age, health status, and identified risk factors.
- Assess and document preventive service needs, provide appropriate diagnostic or follow-up care within 60 days, and record any services offered, even if declined.
- Submit requested medical records promptly when contacted by the Clinical Quality team.
Please note that record requests fall within HIPAA’s provisions for healthcare operations, allowing the exchange of protected health information (PHI) between CenCal Health and provider offices without additional authorization when used for quality improvement and compliance activities.
Focus on ACEs Screening
Adverse Childhood Experiences (ACEs) screenings remain a critical priority for both adult and pediatric members. ACEs such as exposure to abuse, neglect, or household dysfunction are linked to long-term physical, mental, and behavioral health outcomes, including chronic disease, depression, substance use, and risky behaviors. Early identification through routine screening allows providers to intervene proactively, connect members to resources, and support healthier trajectories over the lifespan.
- Screening Frequency:
- Ages 0-20: Screen annually or as clinically indicated if new behavioral, emotional, or physical concerns arise.
- Ages 21 and older: Screen at least once per lifetime.
- Validated Screening Tools:
- PEARLS (Pediatric ACEs and Related Life-events Screener)
- ACE Questionnaire
- Resilience Questionnaire
- Documentation & Follow-Up:
- Record the tool used, results, and any follow-up or referrals in the medical record.
- Use culturally and linguistically appropriate methods to ensure accurate responses.
- Training & Incentives:
- Completing the ACEs Aware Training qualifies providers for a $29 reimbursement per eligible screening for pediatric and adult patients (up to age 65).
- Pediatric patients (0-20 years): Reimbursable once per year; additional screenings may be performed as clinically indicated, but reimbursement is limited to once annually.
- Adult patients (21+ years): Reimbursable once per lifetime.
Further Information
For detailed insights into CenCal Health’s Medical Record Review process, please contact the Clinical Quality team at: medicalrecordreviewprogram@cencalhealth.org
Additional Resources and Tools
For free ACE screening training, visit ACES Aware.
To identify members due for an IHA, access the CenCal Health Provider Portal’s Coordination of Care section under the “Assignment” tab. For additional care overdue for patients, consult the Quality Care Incentive Program (QCIP) section on the Provider Portal.
To explore recommended screenings and preventive health guidelines please visit: