Archived – Medical Review Audit and Corrective Action Plans
Muab tso rau xyoo 2025
Health Net Community Solutions, Inc.
[Lub Sijhawm Tshuaj Xyuas 04/01/22 – 05/31/24]
Tshaj Tawm & Kho Txoj Kev Npaj Ua Haujlwm
Tshaj tawm hauv 2024
AIDS Healthcare Foundation
[Review Period 10/01/22 – 09/30/23]
Tshaj Tawm & Kho Txoj Kev Npaj Ua Haujlwm
Alameda Alliance for Health
[Review Period 06/01/23 – 05/31/24]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Anthem Blue Cross Partnership Plan
[Review Period 10/01/22 – 10/31/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Blue Shield ntawm CA Promise Health Plan
[Review Period 04/01/23 – 03/31/24]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
CalOptima yog
[Review Period 02/01/23 – 02/29/24]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
CalViva Health
[Report Period 04/01/23 – 03/31/24]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Central California Alliance for Health
[Review Period 11/01/22 – 10/31/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Community Health Group Partnership Plan
[Review Period 06/01/23 – 05/31/24]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Contra Costa Health Plan
[Review Period 07/01/22 – 06/30/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Health Plan ntawm San Joaquin
[Review Period 10/01/22 – 07/31/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Health Plan ntawm San Mateo
[Review Period 07/01/22 – 06/30/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Inland Empire Health Plan
[Review Period 08/01/22 – 07/31/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Kaiser
[Review Period 11/01/22 – 10/31/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Kern Health Systems
[Review Period 11/01/22 – 10/31/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Molina Healthcare ntawm California Partner Plan, Inc.
[Review Period 03/01/23 – 02/29/24]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Partnership Health Plan of California
[Review Period 07/01/22 – 06/30/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
San Francisco Health Plan
[Review Period 03/01/23 – 03/31/24]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Santa Clara Family Health Plan
[Review Period 03/01/23 – 01/31/24]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Senior Care Action Network Plan Health Plan
[Review Period 03/01/23 – 02/29/24]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Tshaj tawm hauv 2023
Alameda Alliance for Health
[Review Period 04/01/22 – 03/31/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Anthem Blue Cross Partnership Plan
[Review Period 10/01/21 – 09/30/22]
Tshaj Tawm & Kho Txoj Kev Npaj Ua Haujlwm
Blue Shield ntawm CA Promise Health Plan
[Review Period 04/01/22 – 03/31/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
California Kev Noj Qab Haus Huv thiab Kev Noj Qab Haus Huv
[Review Period 07/01/22 – 06/30/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
[Review Period 05/01/21 – 06/30/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
CalOptima yog
[Review Period 02/01/22 – 01/31/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
CalViva Health
[Review Period 04/01/22 – 03/31/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
CenCal Health
[Review Period 10/01/22 – 09/30/23]
Qhia & (Kho kom raug Action Plan N/A)
[Review Period 10/01/21 – 09/30/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Central California Alliance for Health
[Review Period 11/01/21 – 10/31/22]
Qhia & (Kho kom raug Action Plan N/A)
Community Health Group Partnership Plan
[Review Period 06/01/22 – 05/31/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
[Review Period 06/01/21 – 05/31/22]
Qhia (Cov phiaj xwm kho kom raug tab tom ua tiav)
Contra Costa Health Plan
[Review Period 07/01/21 – 05/31/22]
Qhia (Cov phiaj xwm kho kom raug tab tom ua tiav)
Gold Coast Health Plan
[Review Period 07/01/22 – 06/30/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
[Review Period 06/01/21 – 05/31/22]
Tshaj Tawm & Kho Txoj Kev Npaj Ua Haujlwm
Health Plan ntawm San Joaquin
[Review Period 07/01/21 – 09/30/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Inland Empire Health Plan
[Review Period 08/01/21 – 07/31/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Kaiser
[Review Period 11/01/21 – 10/31/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Kern Health Systems
[Review Period 11/01/21 – 10/31/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
LA Care Health Plan
[Review Period 07/01/21 – 01/31/23]
Qhia (Cov phiaj xwm kho kom raug tab tom ua tiav)
Molina Healthcare ntawm California Partner Plan, Inc.
[Review Period 05/01/22 – 04/30/23]
Qhia & (Kho kom raug Action Plan N/A)
[Review Period 08/01/19 – 04/30/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Partnership Health Plan of California
[Review Period 07/01/21 – 06/30/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
San Francisco Health Plan
[Review Period 03/01/22 – 02/28/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Santa Clara Family Health Plan
[Review Period 03/01/22 – 02/28/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
[Review Period 03/01/21 – 02/28/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Senior Care Action Network Plan Health Plan
[Review Period 03/01/22 – 02/28/23]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Tshaj tawm hauv 2022
Aetna Better Health of California
[Review Period 04/01/21 – 03/31/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
AIDS Healthcare Foundation
[Review Period 01/01/21 – 12/31/21]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Alameda Alliance for Health
[Review Period 04/01/21 – 03/31/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Anthem Blue Cross Partnership Plan
[Review Period 10/01/19 – 07/31/21]
Qhia (Cov phiaj xwm kho kom raug tab tom ua tiav)
Blue Shield ntawm CA Promise Health Plan
[Review Period 01/01/21 – 12/31/21]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Tshaj Tawm (Cal MediConnect) & Kev Npaj Kho Kom Zoo (Cal MediConnect)
CalOptima yog
[Review Period 02/01/20 – 12/31/21]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
CalViva Health
[Review Period 04/01/20 – 03/31/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
CenCal Health
[Review Period 11/01/19 – 09/30/21]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Central California Alliance for Health
[Review Period 11/01/19 – 10/31/21]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Health Net Community Solutions, Inc.
[Review Period 04/01/21 – 03/31/22]
Qhia (Cov phiaj xwm kho kom raug tab tom ua tiav)
Health Plan ntawm San Joaquin
[Review Period 07/01/19 – 06/30/21]
Tshaj Tawm & Kho Txoj Kev Npaj Ua Haujlwm
Health Plan ntawm San Mateo
[Review Period 11/01/19 – 07/31/21]
Daim Ntawv Qhia (Kev Ntsuam Xyuas Kev Kho Mob thiab Cal MediConnect)
Corrective Action Plan (Medical Audit)
Txoj Kev Npaj Kho Kom Zoo (Cal MediConnect)
[Review Period 08/01/21 – 06/30/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Inland Empire Health Plan
[Review Period 10/01/19 – 07/31/21]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Tshaj Tawm (Cal MediConnect) & Kev Npaj Kho Kom Zoo (Cal MediConnect)
Kaiser
[Review Period 09/01/19 – 10/31/21]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Kern Health Systems
[Review Period 08/01/19 – 07/31/21]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
LA Care Health Plan
[Review Period 07/01/19 – 06/30/21]
Qhia (Cov phiaj xwm kho kom raug tab tom ua tiav)
[Review Period 07/01/20 – 06/30/21]
Qhia (Cal MediConnect) (Cov Kev Npaj Kho Kom Zoo tab tom ua tiav)
Partnership Health Plan of California
[Review Period 01/01/20 – 06/30/21]
Qhia & (Kho kom raug Action Plan N/A)
San Francisco Health Plan
[Review Period 03/01/21 – 02/28/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Senior Care Action Network Plan Health Plan
[Review Period 03/01/21 – 02/28/22]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Tshaj tawm hauv 2021
Aetna Better Health of California
[Review Period 04/01/19 – 03/31/21]
Qhia (Cov phiaj xwm kho kom raug tab tom ua tiav)
AIDS Healthcare Foundation
[Review Period 01/01/20 – 12/31/20]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Alameda Alliance for Health
[Review Period 06/01/19 – 03/31/21]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
[Lub Sijhawm Tshuaj Xyuas 10/01/18 – 09/30/20]
Txoj Kev Npaj Kho Kom Zoo (Tsom Mus Rau)
Blue Shield ntawm CA Promise Health Plan
[Review Period 01/01/20 – 12/31/20]
Tshaj Tawm & Kho Txoj Kev Npaj Ua Haujlwm
California Kev Noj Qab Haus Huv thiab Kev Noj Qab Haus Huv
[Review Period 12/01/19 – 04/30/21]
Tshaj Tawm & Kho Txoj Kev Npaj Ua Haujlwm
Community Health Group Partnership Plan
[Review Period 06/01/19 – 05/31/21] (Medical Audit)
[Review Period 06/01/20 – 05/31/21] (Cal MediConnect)
Daim Ntawv Qhia (Kev Tshawb Fawb Txog Kev Kho Mob thiab Cal MediConnect) & Txoj Kev Npaj Kho Kho (Kev Tshawb Xyuas Kho Mob)
Kho kom raug Action Plan (Cal MediConnect)
Contra Costa Health Plan
[Review Period 07/01/20 – 06/30/21]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Gold Coast Health Plan
[Review Period 04/01/19 – 05/31/21]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Health Net Community Solutions, Inc.
[Lub Sijhawm Tshuaj Xyuas 05/01/19 – 03/31/21]
Daim Ntawv Qhia (Txoj Kev Npaj Kho Kom Zoo uas tab tom ua)
[Review Period 04/01/20 – 03/31/21]
Tshaj Tawm (Cal MediConnect) & Kev Npaj Kho Kom Zoo (Cal MediConnect)
[Lub Sijhawm Tshuaj Xyuas 01/01/19 – 12/31/20]
Daim Ntawv Qhia (Tsom Mus Rau) (Txoj Kev Npaj Kho Kom Zoo uas tab tom ua)
LA Care Health Plan
[Review Period 01/01/19 – 12/31/20]
Qhia (Tsom ntsoov) (Cov Kev Npaj Ua Haujlwm Kho Kom Zoo hauv kev kawm)
Rady Children’s Hospital-San Diego
[Lub Sijhawm Tshuaj Xyuas 09/01/19 – 08/31/20]
Daim Ntawv Qhia & Txoj Kev Npaj Kho Kom Zoo
San Francisco Health Plan
[Review Period 03/01/20 – 02/28/21]
Qhia (Cov phiaj xwm kho kom raug tab tom ua tiav)
Santa Clara Family Health Plan
Lub Sijhawm Tshuaj Xyuas 03/01/20 – 02/28/21]
Daim Ntawv Tshaj Qhia & Txoj Kev Npaj Kho Kom Zoo
Senior Care Action Network Plan Health Plan
[Review Period 03/01/20 – 02/28/21]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
United Healthcare Community Plan of California, Inc.
[Review Period 06/01/19 – 05/31/21]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Tshaj tawm hauv 2020
AIDS Healthcare Foundation
[Lub Sijhawm Tshuaj Xyuas 01/01/19 – 12/31/19]
Daim Ntawv Qhia & Txoj Kev Npaj Kho Kom Zoo
Anthem Blue Cross Partnership Plan
[Review Period 10/01/18 – 09/30/19]
Report & Corrective Action Plan
Tshaj Tawm (Cal MediConnect) & Kev Npaj Kho Kom Zoo (Cal MediConnect)
California Kev Noj Qab Haus Huv thiab Kev Noj Qab Haus Huv
[Lub Sijhawm Tshuaj Xyuas 12/01/18 – 11/30/19]
Daim Ntawv Qhia & Txoj Kev Npaj Kho Kom Zoo
CalOptima yog
[Review Period 02/01/19 – 01/31/20]
Report & Corrective Action Plan
CalViva Health
[Lub Sijhawm Tshuaj Xyuas 02/01/19 – 01/31/20]
Daim Ntawv Qhia & Txoj Kev Npaj Kho Kom Zoo
CenCal Health
[Lub Sijhawm Tshuaj Xyuas 11/01/18 – 10/31/19]
Daim Ntawv Qhia & Txoj Kev Npaj Kho Kom Zoo
Central California Alliance for Health
[Lub Sijhawm Tshuaj Xyuas 11/01/18 – 10/31/19]
Daim Ntawv Qhia & Txoj Kev Npaj Kho Kom Zoo
Contra Costa Health Plan
[Lub Sijhawm Tshuaj Xyuas 05/01/19 – 04/30/20]
Daim Ntawv Qhia & Txoj Kev Npaj Kho Kom Zoo
Health Plan ntawm San Mateo
[Review Period 11/01/18 – 10/31/19]
Report & Corrective Action Plan
Inland Empire Health Plan
[Review Period 10/01/18 – 09/30/19]
Report & Corrective Action Plan
Kaiser
[Review Period 09/01/18 – 08/31/19]
Report & Corrective Action Plan
Molina Healthcare ntawm California Partner Plan, Inc.
[Lub Sijhawm Tshuaj Xyuas 08/01/18 – 07/31/19]
Daim Ntawv Qhia & Txoj Kev Npaj Kho Kom Zoo
San Francisco Health Plan
[Review Period 03/01/19 – 02/29/20]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Santa Clara Family Health Plan
[Review Period 03/01/19 – 02/29/20]
Report & Corrective Action Plan
Senior Care Action Network Plan Health Plan
[Review Period 03/01/19 – 02/29/20]
Report & Corrective Action Plan
Tshaj tawm hauv 2019
Aetna Better Health of California
[Review Period 04/01/18 – 03/31/19]
Report & Corrective Action Plan
Community Health Group Partnership Plan
[Review Period 06/01/18 – 05/31/19]
Report & Corrective Action Plan
Contra Costa Health Plan
[Lub Sijhawm Tshuaj Xyuas 06/01/18 – 03/31/19]
Daim Ntawv Qhia & Txoj Kev Npaj Kho Kom Zoo
Health Net Community Solutions, Inc.
[Review Period 05/01/18 – 04/30/19]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Health Plan ntawm San Joaquin
[Review Period 07/01/18 – 06/30/19]
Qhia & (Kho kom raug Action Plan N/A)
Health Plan ntawm San Mateo
[Review Period 11/01/17 – 09/30/18]
Report (Cal MediConnect) & Corrective Action Plan (Cal MediConnect)
Kern Health Systems
[Review Period 08/01/18 – 07/31/19]
Report & Corrective Action Plan
LA Care Health Plan
[Review Period 07/01/18 – 06/30/19]
Report & Corrective Action Plan
Partnership Health Plan of California
[Lub Sijhawm Tshuaj Xyuas 01/01/18 – 12/31/18]
Daim Ntawv Qhia & Txoj Kev Npaj Kho Kom Zoo
San Francisco Health Plan
[Lub Sijhawm Tshuaj Xyuas 03/01/18 – 02/28/19]
Txoj Kev Npaj Kho Kom Zoo
Santa Clara Family Health Plan
[Review Period 04/01/18 – 02/28/19]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Tshaj Tawm (Cal MediConnect) & Kev Npaj Kho Kom Zoo (Cal MediConnect)
Senior Care Action Network Plan Health Plan
[Review Period 03/01/18 – 02/28/19]
Report & Corrective Action Plan
United Healthcare Community Plan of California, Inc.
[Review Period 04/01/18 – 04/30/19]
Report & Corrective Action Plan
Tshaj tawm hauv 2018
Alameda Alliance for Health
[Lub Sijhawm Tshuaj Xyuas 06/01/17 – 05/31/18]
Daim Ntawv Qhia & (Txoj Kev Npaj Kho Tsis Muaj)
CalOptima yog
[Tshawb xyuas Lub Sijhawm 02/01/17 -01/31/18]
Daim Ntawv Qhia & Kev Npaj Ua Haujlwm Kho Kho
Central California Alliance for Health
[Saib Lub Sijhawm Saib Xyuas Lub Sijhawm 11/01/16 – 10/31/17]
Daim Ntawv Qhia & Kho Kev Npaj Ua Haujlwm
Community Health Group Partnership Plan
[Review Period 06/01/17 – 05/31/18]
Report & (Corrective Action Plan N/A)
Contra Costa Health Plan
[Tshawb xyuas Lub Sijhawm 06/01/17 – 05/31/18]
Txoj Kev Npaj Kho Kom Zoo
Gold Coast Health Plan
[Saib Lub Sijhawm Saib Xyuas 04/01/17 – 03/31/18]
Daim Ntawv Qhia & Kho Kev Npaj Ua Haujlwm
Health Net Community Solutions, Inc.
[Lub Sijhawm Tshuaj Xyuas 05/01/17 – 04/30/18]
Txoj Kev Npaj Kho Kom Zoo
Health Plan ntawm San Joaquin
[Lub Sijhawm Saib Xyuas 07/01/17 – 06/30/18]
Tshaj Tawm & Kho Txoj Haujlwm Npaj Ua Haujlwm
Health Plan ntawm San Mateo
[Lub Sijhawm Saib Xyuas 11/01/16 – 09/30/17]
Daim Ntawv Qhia (Txoj Kev Npaj Kho Kom Zoo uas tab tom ua)
Inland Empire Health Plan
[Review Period 10/01/16 – 09/30/17]
Report & Corrective Action Plan
Kaiser
[Review Period 09/01/16 – 08/31/17]
Report (Corrective Action Plan N/A)
Partnership Health Plan of California
[Review Period 01/01/17 – 12/31/17]
Report & Corrective Action Plan
San Francisco Health Plan
[Review Period 03/01/17 – 02/28/18]
Report & Corrective Action Plan
Santa Clara Family Health Plan
[Lub Sijhawm Tshuaj Xyuas 04/01/17 – 03/31/18]
Daim Ntawv Qhia & Txoj Kev Npaj Kho Kom Zoo
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