California Department of Health Care Services Sample Clauses

California Department of Health Care Services. Substance Use Disorder Services – SaaS Cloud Data Analytics (September 2013 – Present) Pondera was awarded the Short‐Xxxxx Data Analytics project in 2013 to detect and help prevent fraud, waste, and abuse in the California Drug Medi‐Cal program. The FDaaS system was implemented within three months of receipt of the client data, and is used to analyze Providers and Beneficiaries in the Medicaid drug and alcohol counseling programs. There are approximately 225,000 beneficiaries and 6,000 providers in the program. A de‐identified screenshot of a Provider Profile shows suspicious behaviors and critical business information. The FDaaS Dashboard for this client displays Alerts, Geospatial Analysis, Link Analysis, Social Network Analysis, and Provider and Beneficiary Profiles. It integrates third party consumer and business data to detect issues with identity, eligibility status (such as age, out‐of‐state indicators, and incarceration status), and potential fictitious businesses (such as shell company activity, credit experience, and criminal histories). It also includes dozens of flags for program specific issues such as holiday xxxxxxxx, xxxxx indicators, and other potential issues. California DHCS also uses the integrated FDaaS Provider Scorecard which ranks and scores every Medi‐Cal Drug Provider for the potential for fraud. The fraud scores are derived from the individual FDaaS flags and allow the DHCS Audits & Investigations (A&I) team to “stack rank” their providers to prioritize field audits. An actual screenshot of the California Scorecard (de‐identified) is provided below. CA DHCS uses the Scorecard to rank all facilities for fraud potential. This is a de‐identified example of the detail behind one of the facilities’ ranking. DHCS also contracted with Pondera to analyze “cross‐over” Beneficiaries who display suspicious activities across DHCS programs. For example, FDaaS is used to identify beneficiaries who are billed for a counseling session in one part of the state while also being billed for an in‐hospital stay in another part of the state. Pondera’s Special Investigations Unit plays an active role on this project. They participate in weekly strike team meetings, analyze data sets and recommend new flags, train DHCS users, and deliver intelligence reports to support DHCS enforcement activities. They also assist DHCS in their meetings with law enforcement agencies.
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Related to California Department of Health Care Services

  • CONTRACTOR California Department of General Services Use Only CONTRACTOR’S NAME (if other than an individual, state whether a corporation, partnership, etc.) BY (Authorized Signature) ✍ DATE SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING ADDRESS STATE OF CALIFORNIA AGENCY NAME BY (Authorized Signature) ✍ DATE SIGNED (Do not type) PRINTED NAME AND TITLE OF PERSON SIGNING Exempt per: ADDRESS Exhibit A Project Summary & Scope of Work

  • Department of Health and Human Services An employee notified of a positive controlled substance or alcohol test result may request an independent test of their split sample at the employee’s expense. If the test result is negative, the Employer will reimburse the employee for the cost of the split sample test. An employee who has a positive alcohol test and/or a positive controlled substance test may be subject to disciplinary action, up to and including dismissal, based on the incident that prompted the testing, including a violation of the drug and alcohol free work place rules.

  • Home Health Care This plan covers the following home care services when provided by a certified home healthcare agency: • nursing services; • services of a home health aide; • visits from a social worker; • medical supplies; and • physical, occupational and speech therapy.

  • COVERED HEALTHCARE SERVICES This section describes covered healthcare services. This plan covers services only if they meet all of the following requirements: • Listed as a covered healthcare service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered healthcare service under this plan. • Medically necessary, consistent with our medical policies and related guidelines at the time the services are provided. • Not listed in Exclusions Section. • Received while a member is enrolled in the plan. • Consistent with applicable state or federal law. We review medical necessity in accordance with our medical policies and related guidelines. Our medical policies can be found on our website. Our medical policies are written to help administer benefits for the purpose of claims payment. They are made available to you for informational purposes and are subject to change. Medical policies are not meant to be used as a guide for your medical treatment. Your medical treatment remains a decision made by you with your physician. If you have questions about our medical policies, please call Customer Service. When a new service or drug becomes available, when possible, we will review it within six (6) months of one of the events described below to determine whether the new service or drug will be covered: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final Food and Drug Administration (FDA) approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). During the review period, new services and drugs are not covered. For all covered healthcare services, please see the Summary of Medical Benefits and the Summary of Pharmacy Benefits to determine the amount that you pay and any benefit limits.

  • Extended Health Care Plan (a) The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable Extended Health Care Plan.

  • Department of Housing and Urban Development This includes a HUD produced video titled “The Basics of the Fair Housing Act” which can be accessed via YouTube at xxxxx://xxx.xxxxxxx.xxx/watch?v=egXPe7HT7tc. Relief for Complainant

  • HEALTH CARE PLANS ‌ Notwithstanding the references to the Pacific Blue Cross Plans in this article, the parties agree that Employers, who are not currently providing benefits under the Pacific Blue Cross Plans may continue to provide the benefits through another carrier providing that the overall level of benefits is comparable to the level of benefits under the Pacific Blue Cross Plans.

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