Potential Quality Concern Notices - (Rev. 4, 07-18-03)

7230 - Potential Quality Concern Notices - (Rev. 4, 07-18-03) In addition to the basic elements listed in §7220, the body of all potential quality concern notices must contain the following elements:  A statement that a QIO physician reviewer has reviewed the medical record;  A summary of the case findings and concerns from the Preliminary Decision portion of the Physician Reviewer Assessment Format (PRAF) (Attaching a copy of the PRAF and referring to the attachment is not acceptable). Although you may reference the PRAF categories for classifying your concerns, do not use the PRAF numbering scheme (e.g., A.1, B.3, C.40, D.99) in your notice. Include sufficient detail so that the parties addressed will clearly understand the identified potential concern;  A statement that the identified concern is a potential concern;  A statement offering an opportunity to discuss the case. Specify the method (either by telephone or in writing is acceptable), the timeframe (20 calendar days), and that your determination will be made on the basis of the medical record alone if no response is received within the stated timeframe. Include the name of a QIO contact person, your address, and telephone number;  For physician notices, a statement that the provider is also being notified of the potential quality concern and given an opportunity to discuss the case. Specify the name of the provider. Do not specify the name of any other physician(s) you may be notifying;  For provider notices, a statement that the involved physician(s) is also being notified of the potential quality concern and given an opportunity to discuss the case. Specify the name of the physician(s); and  A statement encouraging the provider and physician to coordinate their responses to you.