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MedicaidAdministrativeMedium impact

21-607m Changes to Medical Record Review and Corrective Action Plan Verification

Health Net·CA·Prior Authorization
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

Health plans in California can now offer virtual audits for medical record reviews and corrective action plan verifications as an alternative to on-site visits. Providers can choose virtual or on-site audits based on their technical capabilities and needs.

Action Required

Action needed
Immediately: Review technical requirements for virtual audits including dedicated staff availability, computer/phone with Zoom capability, reliable Wi-Fi, electronic medical records system, and private location. If choosing virtual audits, download Zoom software and sign attestation agreement with dedicated nurse auditor. Prepare to provide 10-30 charts depending on provider count (10 for 1-3 providers, 20 for 4-6 providers, 30 for 7+ providers).

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