Medical Audit - Zero Findings

Enhanced compliance expectations from the State of California underscore both a growing reliance by the Medi-Cal program on Managed Care Plans and increased accountability for health plan performance. Audits help identify unnecessary costs and safeguard the appropriate use of resources, ensure accuracy and compliance, improve quality of care, and prioritize member satisfaction. 

In the fall of 2023, the California Department of Health Care Services conducted CenCal Health's annual medical audit. The medical audit evaluated CenCal Health in six performance categories: utilization management, case management and coordination of care, access and availability, member rights, administrative and organizational capacity, and state-supported services. There were also focused audits, which evaluated CenCal Health in transportation and behavioral health.

Audit preparation was a thorough and arduous endeavor. Following three months of preparation, the California Department of Health Care Services performed the two week-long audit and confirmed zero findings in its final audit reports. During their comprehensive evaluation of CenCal Health’s compliance with managed health care law, DHCS found no deficiencies in CenCal Health’s ability to provide quality health care services, the effectiveness of peer review, and utilization control mechanisms, and overall performance in providing health care benefits to its members. 

For CenCal Health, this accomplishment upholds our commitment to integrity, and, most importantly, ensures that members receive appropriate, high-quality care through our provider partners.