Managed Healthcare Unlimited (MHU) partners with state and federal regulatory agencies on routine, onsite audits of commercial health plans and government programs, including Medicaid managed care programs. Regular review of these organizations ensures compliance with statutory requirements governing quality management, enrollee grievances and appeals, access and availability of services, utilization management, continuity of care, emergency services, prescription drug coverage, and language assistance.

All routine audits involve MHU’s team of clinical specialists (physicians, nurses, dentists, and behavioral health experts) in reviewing key documents, conducting case reviews, and interviewing appropriate staff and executives. In collaboration with regulatory agency staff, MHU develops and submits a comprehensive report outlining deficiencies and/or potential deficiencies identified during the audit process as measured against regulatory requirements. Subsequently, MHU conducts follow-up audits to assess the healthcare organization’s efforts to correct the stated deficiencies. MHU has conducted over 300 routine audits of California’s full-service and specialized health plans and programs over the course of two decades.