20-459 Help Your CalViva Patients Achieve Better Health Outcomes

Date: 09/03/20

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

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

 

SUMMARY UPDATE

Use quality management programs and resources to support the care you give

The CalViva Health and Health Net Medi-Cal quality management program is designed to monitor and assess the appropriateness of health and administrative services on a regular basis. A complete overview of the quality management program components is described in provider update 20-459, Help Your CalViva Health Patients Achieve Better Health Outcomes, available in here.

Quality improvement program scope

The program includes developing and implementing standards for clinical care and services, measuring conformance to the standards, and implementing actions to improve performance. The scope of the program includes:

• Impact of COVID-19.
• Quality performance improvement projects.
• Quality measures and surveys.
• Disease management.  
• Health education programs, services and resources.
• Case management program.
• Clinical practice and preventive health guidelines.
• Initial health assessments.
• Health risk assessment.
• Notice of access standards.
• Medical record documentation standards.
• Medical record, facility site and physical accessibility reviews.
• Utilization management.
• Pharmaceutical management.
• Rights and responsibilities.
• Member appeals and grievances.
• Privacy and confidentiality.
• Interpreter services.

If you do not have access to the internet, you may request a print copy of update 20-459. Contact the Health Net Provider Communications Department by email at provider.communications@healthnet.com.

Additional information

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