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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more
California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

21-606m Changes to Medical Record Review and Corrective Action Plan Verification

Date: 08/26/21

Choose virtual or on site audits and verifications based on requirements

Health plans operating in California can now offer virtual audits. This new option applies to medical record reviews (MRRs) and corrective action plans (CAPs)/critical error closures and verifications. You can choose the review option that best fits your needs – virtual or on site. Note: Virtual audits do not apply to facility site reviews (FSRs) which must be done on site.

How we connect

Virtual audits are done with Zoom – a remote communication tool. It connects people with each other for video chat and conferencing. It is HIPAA compliant and password protected. Instructions on how to download Zoom are included at the end of this update.

What you need for a virtual audit

To choose a virtual audit and/or CAP verification, you will need the following:

  • Dedicated staff to assist with the audit and verification.
  • A laptop/computer with Zoom for the MRR portion and a phone with Zoom for CAP verification, if needed.
  • Dependable Wi-Fi and bandwidth.
  • An electronic medical record system for the MRR portion.
  • A private location to review medical records.
  • Time – up to a full day for the MRR portion. Your dedicated nurse auditor will ask for 10 charts for 1–3 providers, 20 charts for 4–6 providers and 30 charts for offices with 7 providers or more.
  • A signed attestation that you agree to a virtual MRR audit.

Your dedicated nurse auditor will help and support you from the beginning to the end of this new process to make it a positive virtual experience.

Exclusions from choosing virtual audit

You will not be able to select virtual audit if any of the following applies:

  • No Wi-Fi or dependable bandwidth to walk around the office and external grounds.
  • For the MRR portion, your office uses paper charts instead of electronic medical records.
  • Zoom is not available on a cell phone, laptop or computer for screen sharing during the MRR.
  • Cannot download medical records to a secure file or provide remote access to your electronic medical records.

If so, the audit will need to be on site and in person.

Download Zoom in four steps

Follow these steps to access Zoom:

  1. Enter Zoom.us in your internet browser.
  2. Scroll down to the web page footer at the bottom and click "Download."
  3. On the Download Center page, click "Download" under the "Zoom Client for Meetings" section.
  4. Zoom will begin downloading.

After you download the application, you can attend meetings by clicking the “Join Meeting” button in a Zoom invitation.

Additional information

Providers are encouraged to access California Health & Wellness Plan’s (CHWP’s) provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305.