The Alliance values our partnership with our network providers. We are committed to keeping you informed and offering you useful resources.
To request any additions to the resources and tools available online, please contact:
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.
Senate Bill (SB) 184 authorizes the Department of Health Care Services (DHCS) to transition the Child Health and Disability Prevention (CHDP) Program effective July 1, 2024. For more information regarding the CHDP transition, please visit the DHCS website: https://www.dhcs.ca.gov/services/chdp/Pages/CHDP-Transition.aspx
Training Material and Resources:
Primary care facilities in the Alliance network are reviewed as a condition of participation in the Alliance network. The purpose of these reviews is to meet quality improvement standards and ensure compliance with applicable local, state, and federal laws and regulations. The site reviews ensure that each provider meets the Alliance’s standards.
Site reviews are conducted for primary care providers (PCPs) during the initial provider credentialing process. Additional PCP site reviews are conducted every three (3) years as part of the ongoing re-credentialing process. The reviews include a site review survey, a medical record review survey, and a physical accessibility review survey assessment.
SR Standards and FSR Tool
MMR Standards and MMR Tool
If you have any questions regarding the site review process, please contact:
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.
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:
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.
At the Alliance, we value our dedicated provider partner community. We are here to help ensure that you have everything that you need to care for Alliance members, and that your experience as an Alliance Provider is positive.
We have created a guide to the Alliance Provider Portal. This guide provides key information on how to create an account, check a patient’s eligibility, coverage and claim status, submit and view authorizations and referrals, submit a provider appeal or dispute, and more.
To view and download the most current Alliance Provider Portal Instructions Guide, please click here.
Please click here to access the Secure File Transfer Website.
The Alliance is committed to helping providers work with Alliance members who face decisions regarding next steps in their care. Below is a patient-centered decision-making tool that will help guide provider-patient interactions.
The Informed Medical Decision Making Foundation describes shared decision-making as such:
Shared decision making (SDM) is a collaborative process that allows patients and providers to make health care treatment decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.
SDM honors both the provider’s expert knowledge and the patient’s right to be fully informed of all care options and the potential harms and benefits. This process provides patients with the support they need to make the best individualized care decisions, while allowing providers to feel confident in the care they prescribe.
One of the resources the Alliance would like to share with you is the Mayo shared decision making resource. This useful content will help patients understand a wide range of health conditions—from diabetes to lower back pain—so they make informed decisions about their care options.
Mayo Clinic: Tools – Care That Fits
The Skilled Nursing Facility (SNF) Workforce & Quality Incentive Program (WQIP) incentivizes facilities to improve quality of care, advance equity in healthcare outcomes, and invest in workforce. SNF WQIP functions as a directed payment program in which the Alliance and other Medi-Cal Managed Care Plan make payments to eligible network providers. To be eligible a SNF must be a contracted network provider.
More information on the SNF WQIP can be found on the Department of Health Care Services (DHCS) website here: https://www.dhcs.ca.gov/services/Pages/SNF-WQIP.aspx.
As a directed payment program, funding for the SNF WQIP is provided by DHCS to the Alliance. DHCS calculates and sends the Alliance the per diem amount for SNF WQIP eligible providers in a payment exhibit. The Alliance has 45 calendar days from receiving the payment exhibits with the per diem amounts from DHCS to make payments to SNF WQIP eligible providers.
SNF WQIP is managed based on Program Year (PY), which equates to calendar year (CY). Payments go out the year following the PY. There is an interim SNF WQIP payment that goes out in the first half of the year following the PY and a final payment that goes out in the second half of the year following the PY.
The SNF WQIP payment for eligible providers is based on SNF WQIP qualifying bed days and the per diem amount from DHCS. DHCS shares data on SNF WQIP qualifying bed days. However, the Alliance is responsible for calculating the number of SNF WQIP qualifying bed days for SNF WQIP eligible providers. The Alliance will share the SNF WQIP qualifying bed days data with eligible providers in an editable digital format within 30 calendar days of receiving the data from DHCS. If a SNF WQIP eligible provider has concerns regarding the qualifying bed days data, the facility and the Alliance can work in partnership to reconcile the data.
How to file a Provider grievance:
SNF WQIP eligible network providers can file a grievance. Grievances may be related to the processing or non-payment of SNF WQIP directed payments or the calculation of SNF WQIP qualifying bed days. The Alliance has a process to accept, acknowledge, and resolve grievances submitted by eligible network providers regarding SNF WQIP. Please complete the form below and email it to the Alliance’s LTSS Liaison, as indicated on the form. The LTSS Liaison will acknowledge receipt of the grievance within three business days.
How to determine the responsible payer: SNF WQIP eligible providers may be contracted with more than one Managed Care Plan (MCP), such as the Alliance. The MCP that holds the network provider agreement with the SNF WQIP eligible provider and is designated as the primary payer under Medi-Cal for a given qualified bed day is the responsible payer.
How to contact the Alliance LTSS Liaison: As required by DHCS, the Alliance has an LTSS Liaison, Carleton Booker. Please reach out to the LTSS Liaison with any questions on the SNF WQIP. Please use this email address: CBooker@alamedaalliance.org.
SNF WQIP Provider Grievance Form (Coming soon)
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