22-202 DHCS Audit Will Now Take Place Via Phone Call

Date: 03/02/22

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 phone interview 

On February 18, 2022 – via provider update 22-155 DHCS Audit Notification – Health Net, on behalf of CalViva Health, notified providers of the upcoming onsite audit visit. We are sending an update to advise you that the audit will now be conducted over the phone instead.  

The Department of Health Care Services (DHCS) will conduct a phone interview audit of CalViva Health to evaluate the plan’s compliance with contractual and regulatory requirements. DHCS will call provider sites any time between April 18, 2022,  through April 29, 2022. 

Audit review period 

The audit review period is April 1, 2020, through March 31, 2022. 

DHCS notification of audit interview

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

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.