26-492 DMHC and DHCS Audit Notification
Date: 04/17/26
Prepare for potential DMHC medical record reviews and/or interviews and DHCS nurse evaluator phone interviews
The Department of Managed Health Care (DMHC) and the Department of Health Care Services (DHCS) will conduct onsite audits of participating physicians, practitioners and other providers in Fresno, Kings and Madera (CalViva Health) counties to assess compliance with contractual and regulatory requirements.
Audit timeline and review period
Agency | Audit timeline | Review period |
|---|---|---|
DMHC | June 16, 2026, through | February 1, 2024, through January 31, 2026 |
DHCS | June 16, 2026, through | April 1, 2025, through |
What to expect
At any time during the above timeline, you may be contacted for:
- DMHC medical record reviews and interviews.
- DHCS nurse evaluator phone interviews.
Review the Rainbow Guide prior to the audit timelines noted above to ensure readiness in the event you are contacted. You should also be prepared to reference the guide during any DMHC or DHCS outreach. The guide includes key requirements and sample audit questions by topic.
Need help? Contact us
If you have questions regarding the audits, contact CalViva Health at
888-893-1569. Behavioral health providers can call 844-966-0298.
This information applies to Physicians, Practitioners, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.