The Alliance partners with the Alameda Contra Costa Medical Association (ACCMA) to support National Healthcare Decisions Day (NHDD) every year on April 16th. We are spreading the word to help inspire and educate our community about the importance of advance care planning. NHDD is a collaborative nationwide effort committed to ensuring that all adults have the information and resources they need to communicate their future healthcare decisions.

Alliance provider partners can help on NHDD and all year long by encouraging your patients to have a conversation with you, their loved ones and friends about their wishes for care in the event they become ill and can’t speak for themselves.

To learn more, please visit the NHDD website.

For resources on advance care planning, please visit the East Bay Conversation Project website.

對聯盟網路中的初級保健設施進行審查,作為參與聯盟網路的一個條件。 這些審核的目的是滿足品質改進標準,並確保遵守適用的當地、州和聯邦法律和法規。 網站審查確保每個供應商都符合聯盟的標準。

在最初的提供者認證過程中,對初級保健提供者 (PC) 和產科/婦科提供者進行網站審查。 作為正在進行的重新認證過程的一部分,每三 (3) 年可能進行一次其他 PCP 網站審查。 審核包括現場審查調查、醫療記錄審查調查和物理無障礙審查調查評估。

資源(即將推出)

• DHCS 所有計劃信函
• DHCS 設施現場審查調查
• DHCS 醫療記錄審查調查
• DHC MMCD 政策函 14-004
• DHCS 物理輔助功能審查調查
• FSR/MRR 檢查表

聯繫

如果您對網站審核流程有任何疑問,請聯繫:

• Alliance Provider Services Department
• Monday - Friday, 7:30 am – 5 pm
• Phone Number: 1.510.747.4510
• Email: providerservices@alamedaalliance.org

The American Medical Association (AMA) has many helpful tools to assist physicians understand and comply with the different components of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), including sample forms and documents, updates on new guides from the federal government, and useful compliance tips. For more HIPAA resources, please visit AMA.

For information on fraud, waste, and abuse, or to report a potential compliance issue, please click here.

To report a potential compliance issue, please fill out the Compliance Incident Report Form:
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Beginning July 1, 2012, federal law requires that all providers report provider-preventable conditions (PPCs) that occurred during treatment of Medi-Cal patients. Providers must report all PPCs that are associated with claims for Medi-Cal payment or with courses of treatment given to a Medi-Cal patient for which payment would otherwise be available. Providers do not need to report PPCs that existed prior to the provider initiating treatment for the beneficiary.

The Federal Affordable Care Act section 2702 and Title 42 of the Code of Federal Regulations, sections 447, 434 and 438 also require that Medi-Cal and Medi-Cal Managed Care plans no longer reimburse providers for PPCs that occur during treatment of Medi-Cal patients. The Alliance will investigate all reports of PPCs, including those it discovers through any means, to determine if payment adjustment is necessary.

Interested providers may read the State Plan Amendment (SPA) for PPCs, which took effect July 3, 2012.

Reporting Requirements

For Alliance Medi-Cal members, providers must report directly to the Alliance using the PPC reporting form within five (5) business days of discovery of the PPC and confirmation that the patient is a Medi-Cal beneficiary.

To receive a copy of the form, please contact:

• Alliance Provider Services Department
• Monday - Friday, 7:30 am – 5 pm
• Phone Number: 1.510.747.4510
• Email: providerservices@alamedaalliance.org

Please submit forms to:

Alliance Compliance Department
Fax: 1.510.373.5999
Email: compliance@alamedaalliance.org

Please note that reporting PPCs for a Medi-Cal beneficiary does not preclude the reporting of adverse events and healthcare-associated infections (HAI) to the California Department of Public Health pursuant to Health and Safety Code.

Please click here to access the Secure File Transfer Website.