The Department of Health Care Services (DHCS) will conduct a routine medical audit of the Alliance in November. This audit will evaluate the Alliance’s compliance with contractual and regulatory requirements.
A component of the audit may include site visits of select provider offices to conduct medical record reviews of specific members’ records. DHCS nurse evaluators will collect copies of members’ medical records and conduct brief interviews with providers and/or staff regarding coordination of care. These nurse evaluators have signed confidentiality agreements, and will conduct record reviews and clinic staff interviews in accordance with HIPAA regulations.
You may be contacted by DHCS sometime in the next few weeks to schedule an onsite visit.
Please be aware that DHCS, as a health oversight agency conducting activities necessary for appropriate oversight of government benefit programs, 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).
If you have questions, or for more information, please contact a Provider Relations Representative at (800) 700-3874, ext. 5504.