Why This Matters
County Behavioral Health Plans perform QA/UR and Administrative activities every day that are essential to operating programs delivering Medi-Cal services, including compliance, oversight, fiscal operations, and program administration. While many of these activities may be allowable for claiming, they are often not consistently documented, tracked, reviewed, or compiled for claiming purposes.
Gaps in how these activities are tracked, documented, and compiled can leave allowable federal reimbursement unclaimed. The following approach is designed to close that gap by centralizing and standardizing activity capture for reporting and claiming.
The SmartCare QA/UR and Administrative Activity Details Tracker and corresponding QA/UR and Administrative Activity Report were developed to help counties systematically capture and report QA/UR and Administrative activities that are essential for the delivery of Medi-Cal services. These tools provide a standardized framework for both clinical and non-clinical staff to document their activities in support of stronger, more compliant claiming and reimbursement opportunities.
Even a small number of staff performing claimable QA/UR and Administrative activities throughout the year can represent thousands of dollars in potential federal reimbursement. By capturing these activities directly within SmartCare, counties can improve oversight, strengthen compliance, and support reimbursement opportunities for allowable activities.
Key Benefits to Counties
- Support Identification of Claimable Activities – Helps county staff identify and capture QA/UR and Administrative activities that may qualify for Federal Financial Participation (FFP), supporting the documentation needed to substantiate claims and reducing the risk of missed claiming opportunities.
- Improve Documentation and Allocation – Provides a structured process for documenting activities, assigning delivery systems, identifying Proposition 30-related activities, and supporting appropriate cost allocation.
- Strengthen Supervisory Review and Oversight – Supports review of activity descriptions, classifications, documentation quality, and compliance prior to claim preparation.
- Simplify Claim Preparation – Provides finance and fiscal staff with organized activity data that can be compiled, validated, allocated, and incorporated into quarterly QA/UR or Administrative claims.
- Enhance Compliance and Audit Readiness – Creates a centralized record of activities and supporting information that can be used to support claims, supervisory review, fiscal oversight, and audit readiness.
- Leverage Supporting Resources – Complements the Policy Playbook, QA/UR + Administrative Claiming EHR Custom Code Set, County Guide to Tracking QA/UR and Administrative Activities, Allocation & Organization of Administrative Costs, role-based cheat sheets, and other resources developed to support compliant claiming practices.
Additional Information
For additional information on how to support accurate and compliant QA/UR and Administrative claiming, refer to the Policy Playbook: Maximizing QA/UR and Administrative Claiming.