Department Of Health Care Services Medical Review Branch

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Medical Review Audits and Corrective Action Plans

https://www.dhcs.ca.gov/services/Pages/MedRevAuditsCAP.aspx

The medical survey is a comprehensive evaluation of the MCP's compliance with managed health care law Period(Knox-Keene Health Care Service Plan Act). DHCS’ Managed Care Quality and Monitoring Division (MCQMD) is responsible for ensuring …

Department of Health Care Services Contacts - California

https://www.dhcs.ca.gov/Pages/dhcs_contact.aspx

Jun 9, 2022

Audits & Investigations - California

https://www.dhcs.ca.gov/individuals/Pages/AuditsInvestigations.aspx

Missio n. Audits and Investigations Division (A&I) is the designated Program Integrity Unit (PIU) for the Medi-Cal program. A&I’s mission is protect and …

Medical Review Branch - Payment Error Rate …

https://www.dhcs.ca.gov/individuals/Pages/AI_MRB_PERM.aspx

PERM is comprised of three review components: Fee-for-Service (FFS) paid claims, Managed Care (MC) capitation payments, and Eligibility. For the FFS review …

DHCS Homepage - California

https://www.dhcs.ca.gov/

The budget for DHCS supports vital services that reinforce the state’s commitment to preserve and improve the overall health and well-being of all Californians while operating …

Division Directory | DHCS - California

https://www.dhcs.ca.gov/Pages/DivisionDirectory.aspx

Managed Care Quality and Monitoring Medi-Cal Behavioral Health Medi-Cal Dental; Medi-Cal Eligibility Office of Administrative Hearings and Appeals Office of …

About the Department of Health Care Services - California

https://www.dhcs.ca.gov/Pages/AboutUs.aspx

Among the programs administered by DHCS, some of which are mandated by the federal government and others required by state law, are California Children’s Services; Child Health and Disability …

A&I - Investigations Branch - California

https://www.dhcs.ca.gov/individuals/Pages/AI_IB_Provider.aspx

DHCS/IB investigates “preliminary” provider fraud complaints. After a preliminary investigation is completed and reasonable cause has been established to …

Medi-Cal: Post-Service, Prepayment Audit (PPM Audit) …

https://files.medi-cal.ca.gov/pubsdoco/special_claims_faq.aspx

A. A PPM Audit (formerly known as Special Claims Review [SCR]) is a utilization control process that the Department of Health Care Services (DHCS) uses to …

Complaints & Appeals | HHS.gov

https://www.hhs.gov/regulations/complaints-and-appeals/index.html

Complaints & Appeals | HHS.gov Home > Laws & Regulations > Complaints & Appeals Text Resize A A A Print Share Complaints & Appeals If you believe you have been …

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