The Department of Health Care Services (DHCS) will conduct a routine medical audit of the Alliance in early 2024. This audit will evaluate the Alliance’s compliance with contractual and regulatory requirements.
The audit will include onsite review of a select number of provider offices. DHCS Nurse Evaluators may review members’ medical records and conduct brief interviews with providers and/or staff regarding coordination of care. These nurse evaluators have signed confidentiality agreements. They will conduct record reviews and clinic staff interviews in accordance with HIPAA regulations.
You may be contacted directly by a DHCS Nurse Evaluator within the next few months to schedule an interview.
Please be aware that as a health oversight agency conducting activities necessary for appropriate oversight of government benefit programs, DHCS has the authority to review confidential information (see Title 45, Code of Federal Regulations, Subpart E, Sections 164.512, 164.506 and 164.512(d)).
For more information, please contact an Alliance Provider Relations Representative at 800-700-3874, ext. 5504.
