As we reflect on the 2025 Medical Record Review (MRR) Program, CenCal Health extends its sincere appreciation to our provider partners for your continued collaboration and dedication to quality care. Your efforts support timely preventive services, appropriate risk identification, and follow-up care in alignment with evidence-based clinical guidelines. The 2025 review highlights meaningful areas of strength, along with opportunities to further improve consistency and comprehensive documentation across adult and pediatric populations.
2025 Overall Findings
The 2025 MRR Program demonstrated strong performance in several core preventive care domains, particularly cancer screenings, behavioral health screening, and pediatric sensory and oral health services. At the same time, variability across quarters revealed opportunities to strengthen consistency in risk-based screenings and early intervention services.
High-Performance Areas
Adult Preventive Screenings and Services
- Clinical Depression Screening (consistently high performance across all quarters)
- Tobacco Use Screening
- Breast Cancer Screening
- Colorectal Cancer Screening
- Cervical Cancer Screening
- STI Behavioral Counseling for members identified as high risk
- TB Screening (PPD) for members identified as high risk
Pediatric Preventive Screenings and Services
- Vision Risk Assessment and Vision Screening (Visual Acuity)
- Hearing Risk Assessment and Hearing Screening (Audiogram)
- Oral Health Screening
- Autism Spectrum Disorder Screening
- Clinical Depression Screening (when age-appropriate)
- TB Screening (PPD) for members with increased risk
- Lead Screening (blood levels)
- STI Screening for Chlamydia and Gonorrhea (when indicated)
- TB Risk Assessment
Opportunities for Improvement
Adult Preventive Screenings and Services
- Adverse Childhood Experiences (ACEs) Screening
- Alcohol and Drug Use Screening (requires use of validated screening tool)
- Hepatitis C Screening
- HIV Screening
- TB Risk Assessment
- STI Screening for Chlamydia and Gonorrhea
- Consistent completion of STI Behavior Risk Assessments
Pediatric Preventive Screenings and Services
- Alcohol and Drug Use Screening (requires use of validated screening tool)
- ACEs Screening
- Developmental Screening
- Dyslipidemia Screening and Risk Assessment
- Lead Risk Assessment
- Fluoride Varnish application
- HIV Screening (when age- and risk-appropriate)
These findings highlight the importance of systematic screening workflows, accurate risk identification, and complete documentation within the medical record.
Primary Care Practitioners’ Responsibilities
Primary Care Practitioners (PCPs) play a critical role in ensuring delivery of high-quality, preventive, and follow-up care. Responsibilities include:
- Initial Health Assessment (IHA) is completed within 120 days of a new member assignment. Patients due for an IHA can be found in the Provider Portal under Care Coordination. For newly enrolled Medicare patients, the Initial Preventive Physical Exam (IPPE) is completed within the first 12 months of enrollment.
- Wellness Visits: Scheduled according to age, health status, and identified risk factors.
- Preventive and Follow-Up Services: Timely diagnostic, treatment, and follow-up services, generally within 60 days of identifying abnormal findings or unmet preventive needs.
- Comprehensive Documentation: Medical records should clearly reflect:
- Complete physical and behavioral health history, including social and family history
- Current physical and behavioral health examination
- Perinatal services, when applicable
- Oral health assessments, dental screenings, and referrals
- Age- and gender-specific preventive screenings
- Age-appropriate immunizations
- Risk assessments (e.g., ACEs, substance use, TB, dyslipidemia)
- Health education and anticipatory guidance
- Diagnoses, treatment plans, and follow-up actions
- Any refusals of immunizations, screenings, or recommended services
While not all recommended services must be completed during a single visit, a comprehensive needs assessment should be conducted and documented, with services delivered or scheduled in alignment with established clinical guidelines.
Looking Ahead to 2026
In 2026, CenCal Health will continue refining the Medical Record Review process to enhance data accuracy, improve feedback timeliness, and support targeted quality improvement initiatives. Our goal remains to partner with providers in advancing preventive care delivery and improving health outcomes for our members.
Beginning in 2026, the Medical Record Review Program will also expand to include reviews of Dual Eligible Special Needs Plan (D-SNP) members. This expansion will further support comprehensive, coordinated care for members with complex medical and social needs and align review activities with applicable Medicare and Medi-Cal quality requirements. Additional guidance and education will be shared with providers prior to implementation.
Thank you for your continued dedication and collaboration. Together, we can strengthen preventive care delivery and improve health outcomes for our members across the lifespan.
For questions regarding the Medical Record Review Program, please contact the Clinical Quality team at: medicalrecordreviewprogram@cencalhealth.org
Additional Resources and Tools
CenCal Health Provider Portal:
Identify members due for an Initial Health Appointment (IHA) under the Coordination of Care section, “Assignment” tab.
Review additional care gaps via the Quality Care Incentive Program (QCIP) section.
Free ACEs Screening Training:
Providers are encouraged to complete ACEs Aware training to support trauma-informed care. Eligible providers who complete and attest to the training may receive a $29 payment per screening. Visit ACES Aware for more information.
Evidence-Based Preventive Care Guidelines