Site Evaluations

Practioners participating in Cal MediConnect may be required to have a completed facility site review (FSR) as a precondition for inclusion into the network. Each FSR is conducted every three years by Health Net or an eligible participating party through the Industry Collaboration Effort (ICE).

Health Net or its designee also conducts FSRs to investigate member complaints relating to any practice location, regardless of practitioner specialty. A review of member complaint reports or related information is conducted at least every 60 days.

Events that initiate an investigation to conduct a site visit include, but are not limited to:

• Physical accessibility.
• Physical appearance.
• Adequacy of waiting and examining room space.

When there are member complaints, a Health Net Medical Site Coordinator or designee conducts office site evaluations using an approved Health Net Site Evaluation Tool, which consists of the following elements:

• Physical accessibility.
• Physical appearance.
• Adequacy of waiting and examining room space.
• Equipment.
• Medical record-keeping.
• Other issues, including safety.

Each criterion on the site tool is weighted equally. If the office site audit has an overall score below 100 percent, the applicable department creates a corrective action plan (CAP) that outlines deficient criteria and the actions that need to be taken by the office.

Participating providers who refuse an office site evaluation, do not meet the CAP within a specified time frame or who refuse to participate in the CAP are referred to the Health Net Credentialing Committee for administrative denial or termination. This administrative denial or termination applies to all Health Net lines of business. Sites that have complied with a CAP are retained in the Health Net network.

Refer to Facility Site Review under the Quality Improvement section for more information.