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22670 Haggerty Road, Suite 100, Farmington Hills, Michigan 48335

Phone: 248-465-7300  |  Fax: 248-465-7428 

At MPRO, we are committed to maintaining an environment of equal opportunity and affirmative action. If you need a reasonable accommodation to access the information provided on this website, please contact us at 248-465-7300 for further assistance.

See a sample letter

Medical Records Request

 

Date

 

Medical Records - Medicaid Liaison

 

Address

 

NPI #

 

Audit ID

 

Dear Medicaid Liaison,

 

The Michigan Department of Community Health (MDCH) is responsible for the administration of the Michigan Medicaid program. As part of this responsibility, the Office of Health Services Inspector General (OHSIG), an independent office within DCH, conducts and supervises audits and reviews of Medicaid providers.  These audits and reviews are performed to ensure compliance with applicable laws, rules, regulations and policies of the Michigan Medicaid program pursuant to The Social Welfare Act, 1939 PA 280, MCL 400.1 to 400.119.

 

Add scenario here

 

The State of Michigan has contracted with Michigan Peer Review Organization (MPRO) to perform post payment audits under OHSIG’s supervision. MPRO will conduct a medical record review to validate the appropriateness and accuracy of claims submitted by your hospital. Attached is a list of records which have been selected for review. Please forward copies of the original records for all dates of service listed. Supporting documentation may include the following:

 

  • Physician encounter notes and exams

  • Flow sheets

  • Operative reports

  • Diagnostic results

  • Nursing notes

  • Medication records

  • Hospital admission history and physical

  • Discharge summary

  • ER record

  • Physician orders and progress reports

  • Lab, x-ray and pathology reports

 

Please submit these records within 30 days of the date of this letter. Do not send original records. You may submit your records via paper, secure fax, CD/DVD, secure email or electronically. Be sure to submit all documentation necessary to substantiate your billings.

 

Due date

 

For correct handling and delivery of these records, you must enclose a copy of this request letter. MPRO will not be responsible for inappropriate routing of your records when a copy of our request is not attached.

 

Documentation submitted by secure fax should be faxed to:
Fax: 248-465-7303

To send your documentation via MPRO secure file exchange:
Instructions found on the web site www.mproaudit.org – click ‘Secure File Exchange Instructions’ on the left tab.  

You can mail all requested documentation or send all CD/DVD copies to:
MPRO
Attn: HPPAC
Address: 22670 Haggerty Road, Suite 100
Farmington Hills, MI 48335
Phone: 248-465-7300