22-1043 New Update to PPG's Delegated Agreement to Help Providers Manage Delegated Responsibilities

Date: 12/07/22

Effective February 13, 2023, delegation agreements will be issued at the start of the year

Health Net*, on behalf of CalViva Health, is responsible for the oversight of all delegated physicians and other providers to ensure regulatory requirements are met in performing delegated functions. Delegated participating physician groups (PPGs) are issued an updated delegation agreement following the completion of their annual delegation oversight audit.

As of February 13, 2023, the delegation agreements will be issued as follows:

• Delegation Oversight will issue delegation agreements separate from the annual audit. This change will allow us to review the agreement independent of the Annual audit results.
• New delegation agreements will be issued to our delegated PPGs in the beginning of the year. They will no longer be issued at the end of the annual audit.

Off-cycle delegation agreements may also be issued by the Plan

Health Net and CalViva Health reserve the right to issue off-cycle delegation agreements to include the change and:

• Delegates will have 14 calendar days to review and submit with the appropriate signatures.
• Upon receipt, Health Net and CalViva Health will put into effect a new delegation agreement.
• A copy of the agreement will be issued to the delegated PPG.

Revocation of delegation agreement

Delegation agreements are reviewed annually to update and include regulatory, contractual, and NCQA standard updates; and revisions and or new requirements as needed. Health Net and CalViva Health reserve the right, upon written notice, to revoke the delegation of some or all responsibilities for CalViva Health members’ PPGs. If the delegate does not perform the responsibilities as defined in the Plan/PPG/Provider Delineation of Delegated Responsibilities grid in accordance with the Plan, NCQA and regulatory standards:

• Delegate will have a thirty (30) day cure period prior to revocation (except in the event of risk to members).
• Delegation agreements shall remain in effect unless the delegate is notified by Health Net of a status change.

Additional information

Providers are encouraged to access the provider portal 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 888-893-1569.

 

This information applies to Participating Physician Groups (PPGs).

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