Audits
The frequency of audits conducted by Department of Healthcare Services (DHCS) on L.A. Care.
What is annual?
P&Ps
Policies & procedures
This team member loves to coordinate outfits with their spouse when they go out.
Who is Rosie?
L.A. Care's DHCS Contract Manager for Cal MediConnect (CMC)
Who is Pete Plesha?
Who is Thomas Mapp?
CMS refers to the audit review period for their validation audits as this.
What is the "clean period"?
APL
What is All Plan Letter?
This team member's favorite food is Biryani and is originally from Karachi, Pakistan.
Who is Motahir?
L.A. Care's CMS Contract Manager.
The Director of the department that oversees all member complaints/member dissatisfaction.
Who is LisaMarie Golden?
This type of audit focuses on ensuring reports submitted are in alignment with our systems and are accurate.
What is a data validation audit?
CFR
What is Code of Federal Regulations?
This team member's favorite food is seafood (shrimp & sushi). Another hint: This team member would love to travel to Santorini, Greece with their daughter.
Who is Jadira?
L.A. Care's DHCS Contract Manager for Medi-Cal.
Who is Mary Cobb?
The Manager who oversees internal claims compliance.
Who is Ann Reaves?
The DMHC conducts this type of survey to test the correction of findings.
What is DMHC Follow Up Survey?
This staff member's deepest and truest passion is animal rights.
Who is Amanda Ghattas?
California's Knox Keene Act requires California managed care plans to obtain a license from this regulatory agency.
What is the Department of Managed Healthcare (DMHC)?
Utilization Management (UM) and Care Management (CM) report to this Chief.
Who is the Chief Operating Officer/Acacia Reed?
A 2-step process that occurs after receiving regulatory audit findings.
What is root cause analysis and corrective action plans?
HPMS
What is Health Plan Management System?
This staff member is on a cover of a mystery novel.
Who is Chelsea Hertler?
A monthly meeting held by our CMS and DHCS contract managers and stakeholders to discuss a variety of topics surrounding our CMC line of business.
CMT Meeting/L.A. Care Monthly MMP Call
Who is Victor Hurtado?