20-066 DHCS Audit Notification

Date: 01/15/20

This information applies to Physicians and Participating Physician Groups (PPGs).

This information applies to Medi-Cal in Fresno, Kings and Madera counties.

Be prepared for your onsite visit

The Department of Health Care Services (DHCS) is conducting an onsite audit of
CalViva Health to evaluate the plan’s compliance with contractual and regulatory requirements. As part of the audit, DHCS may visit provider sites any time during February 3, 2020, through February 14, 2020.  

Audit review period

The audit review period is February 1, 2019, through January 31, 2020.

DHCS notification of visit

DHCS is going to visit select provider offices. If selected, a nurse evaluator will contact you directly to schedule an onsite visit. Cooperation with DHCS staff is required.

Additional information

Providers are encouraged to access the provider portal online at provider.healthnet.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact
CalViva Health at 1-888-893-1569.