Accepting New Provider Contracts

8990 Westminster Boulevard, 3rd Floor, Westminster, California 92683, United States

(657) 224-1888

Clever Care Health Plan

A Clever Medicare Plan

QUALITY ASSURANCE

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Commitment to highest clinical quality

Our member health is the most important to us. Only qualified medical expertise will engage in the treatment of patients, authorize treatment, refer patients for treatment and deny treatment when medically unnecessary. 

Our Chief Medical Officer chairs the Quality committee; and is not a member of any financial committee. Chief Medical Officer reports quality assurance oversight directly to the governing board. 

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No incentive for under-utilization or denials

Clever Care is highly committed to provide the healthcare needs of our members. We never compensates or provides incentives to practitioners or any individuals for conducting utilization review for denials of coverage or services. Utilization decisions are made solely on medical appropriateness of care and services under the supervising of Chief Medical Officer. 


Clever Care will not award any type of incentive to any individuals or entities for conducting utilization review decisions that may result in under utilization.


All employees shall not derive any personal profit or gain, directly or indirectly, by reason of his or her participation in the decision-making activities relative to their role in the organization. 

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Independent Audit and Compliance Function

Clever Care protects its integrity as government contractor. Our Compliance and Audit department report directly to the governing board - independent from operational management.


Clever Care deploys 3 lines of defense to manage its risk:

  1. First line of defense: Operational management has ownership, responsibility and accountability for directly assessing, controlling and mitigating risks.
  2. Second line of defense: Internal governance (compliance, risk management, quality, IT and other control departments) monitors and facilitates the implementation of effective risk management and assists the risk owners in reporting adequate risk related information up and down the organization.
  3. Third line of defense: An independent internal audit function will provide assurance to the organization’s board of directors and senior management. This assurance will cover how effectively the organization assesses and manages its risks and will include assurance on the effectiveness of the first and second lines of defense. It encompasses all elements of an institution’s risk management framework (from risk identification, risk assessment and response, to communication of risk related information) and all categories of organizational objectives: strategic, ethical, operational, reporting and compliance.

Star Rating and Coding Accuracy

Preventive Medicine

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Clever Care promotes healthy living and preventive medicine to our members.

Star Rating

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Our members are Stars, and deserved a Star health plan.


Disclaimer: Every year, Medicare evaluates plans based on a 5-star rating system.

Healthcare Data/Coding Accuracy

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We believe in accurate and actionable data.  We will collaborate with our provider partners to capture accurate health data that enable accurate personalized treatment plan that works.