20-032 A More Centralized and Collaborative Approach to Delegation Oversight
Date: 01/09/20
Delegation Oversight Interactive Tool (DOIT) available in first quarter 2020
In October 2019, delegated entities had a chance to view an introductory presentation of the DOIT. Following this introduction, you should have provided the information to set up your entity in DOIT. When your implementation date is set, the Delegation Oversight Department will reach out to your group to start the transition. This will include details on the roll-out schedule.
In 2020, California Health & Wellness Plan (CHWP) will be rolling out phase 1 of DOIT. This tool will be used by all delegated entities to submit reports, monitor performance, complete audit activity, track corrective action, and more. Key features include, but are not limited to:
- A single location for all for all data submissions/reports required for utilization management (UM)
- Pre-audit and audit activities.
- Issue management and corrective action plan (CAP) management.
Note: Phase 1 is only for UM activities.
Single point of interaction between delegated entities and Delegation Oversight
Delegated entities will have one login for their group to access DOIT. When you log in to DOIT, you will be taken to your landing page that includes:
- Tasks initiated, including their due dates.
- List of required reports and upload capability for each report, key performance indicator reports, and other performance reports.
Centralized report submission
All required reports/log submissions for UM will be through DOIT. Some functionalities include:
- Timely error reports on files submitted.
- Immediate visibility on load status.
Centralized location for all audit activities
All activity related to audits will be done through DOIT. This includes pre-audit document gathering, document requests for file review, the actual audit itself, draft of the audit findings, and the final audit result report.
Revised audit scope
Delegated entities will now do a pre-audit survey through DOIT, which will include automated reminders to complete all pre-audit tasks.
With DOIT, the process for audits will change to include process walk-throughs, interviews, file review, data validation, and more. Audits will consist of the following focus areas:
- UM program structure
- Decision-making criteria
- Access to staff
- Appropriate professionals
- Timeliness
- Denials
- Accuracy
- Care coordination
- Complex case management
- Special needs plan (SNP)
- Cal MediConnect case management
- Delegation
Revised scoring model
The audit areas noted above are measured independently and rolled into the overall score. Annual audit scoring in DOIT will be risk-based and more dynamic:
- Each audit question is risk rated.
- Audit scores are satisfactory, needs improvement or fail.
Centralized issue management
Issues, including corrective actions, audit-related or otherwise, are tracked, monitored and managed through DOIT.
Training for you and your staff
CHWP will provide you with training, including interactive training to provide to your staff. This training module can also be used to train new staff as they come on board. In addition, there will be Webex opportunities for users to learn how to interact with the tool to ensure a smooth transition.
Additional information
If you have any questions on DOIT, please email Delegation_Oversight_Group@Centene.com.
Relevant sections of the provider operations manual will be revised in 2020 to reflect information regarding DOIT. Providers will be notified when these changes have been made, as appropriate.
If you have questions regarding the information contained in this update, contact CHWP at 1-877-658-0305.