As a new Alliance Group Care member, we created handouts for you to learn more about your health plan, and your benefits and covered services.

Welcome Letter
English | Spanish | Chinese

Advice Nurse Line Flyer
English | Spanish | Chinese

Alliance Group Care Member Handbook – Combined Evidence of Coverage (EOC) and Disclosure Form
English | Spanish | Chinese

Alliance Group Care Provider Directory (all languages)

Alliance Interpreter Services
Language Assistance Services

California Immunization Registry (CAIR) Letter
English | Spanish | Chinese

Emergency Room (ER) Flyer
English | Spanish | Chinese

IHSS+ Alzheimer’s (In-Home Supportive Services) Provider Training Program
English | Spanish | Chinese

Member Portal Flyer
English | Spanish | Chinese

Nondiscrimination Notice
English | Spanish | Chinese

PG&E Public Safety Power Shutoff (PSPS) Program
English | Spanish | Chinese

Summary of Benefits and Glossary
English | Spanish | Chinese

Your Health Care Checklist
English | Spanish | Chinese

Your Primary Care Provider (PCP) Is Important
English | Spanish | Chinese

Wellness Programs and Materials Request Form
English | Spanish | Chinese

We want you to get the most out of your health plan. Your Alliance Group Care Member Handbook also known as the Combined Evidence of Coverage (EOC) and Disclosure Form is mailed to our members annually.
English | Spanish | Chinese

To view a copy of the Alliance Provider Directory for Group Care members, please click here.

You can also search for a provider in our online Alliance Provider Directory.

Pre-approval (prior authorization)

For some types of care, your PCP or specialist will need to ask the Alliance for permission before you get the care. This is called asking for prior authorization, prior approval, or preapproval. It means that the Alliance must make sure that the care is medically necessary or needed. Medically necessary services are reasonable and necessary to protect your life, keep you from becoming seriously ill or disabled, or reduce severe pain from a diagnosed disease, illness or injury. For members under the age of 21, Medi-Cal services includes care that is medically necessary to fix or help relieve a physical or mental illness or condition.

The following services always need pre-approval (prior authorization), even if you get them from a provider in the Alliance network:

• Hospitalization, if not an emergency
• Services out of the Alliance service area, if not an emergency or urgent
• Outpatient surgery
• Long-term care at a nursing facility
• Specialized treatments
• Medical transportation services when it is not an emergency. Emergency ambulance services do not require pre-approval.
• Outpatient diagnostic and radiology services, minimally invasive or invasive, such as CT scans, MRIs, cardiac catheterization, PET
• Home Health Care, including skilled nursing, nursing aides, rehabilitation therapies, and social workers

Under Health and Safety Code Section 1367.01(h)(1), the Alliance will decide routine preapprovals (prior authorizations) within five (5) working days of when the Alliance gets the information reasonably needed to decide.

For requests in which a provider indicates or the Alliance determines that following the standard time frame could seriously endanger your life or health or ability to attain, maintain, or regain maximum function, the Alliance will make an expedited (fast) preapproval (prior authorization) decision. The Alliance will give you notice as quickly as your health condition requires and no later than 72 hours after getting the request for services.

Pre-approval (prior authorization) requests are reviewed by clinical or medical staff, such as doctors, nurses and pharmacists. The Alliance does not pay the reviewers to deny coverage or services. If the Alliance does not approve the request, the Alliance will send you a Notice of Action (NOA) letter. The NOA letter will tell you how to file an appeal if you do not agree with the decision. The Alliance will contact you if the Alliance needs more information or more time to review your request.

You never need pre-approval (prior authorization) for emergency care, even if it is out of the network and out of your service area. This includes labor and delivery if you are pregnant.

You do not need pre-approval (prior authorization) for sensitive services, such as family planning, HIV/AIDS services, and outpatient abortions. For questions about pre-approval (prior authorization), call:

• Alliance Member Services Department
• Monday – Friday, 8 am – 5 pm
• Phone Number: 1.510.747.4567
• Toll-Free: 1.877.932.2738
• People with hearing and speaking impairments (CRS/TTY): 711/1.800.735.2929

Pre-Service Authorizations

The Alliance Utilization Management (UM) Department must review and approve some types of care before they are provided. Your primary care provider (PCP) or specialist will work with the Alliance UM to get pre-service authorizations. The Alliance UM clinical review team of doctors determine whether the service is clinically appropriate, performed in the appropriate setting, and a part of your covered benefits.

Your PCP or specialist will give the Alliance UM team the clinical information that is needed for all services that require a medical necessity review. Your PCP or specialist must select the “Type of Request” on the Prior Authorization (PA) Request Form.

Your PCP or specialist must also include all supporting clinical information with the initial request to help ensure a timely decision. If the clinical review information is not received with the PA Request Form, the Alliance UM team will contact your PCP or specialist to collect the needed information.

Clinical information about a member may include:

• Consultations
• Diagnostic results
• History of presenting problem
• Member’s response to treatment
• Photographs
• Physical assessment
• Previous and current treatment

Your PCP or specialist should provide clinical information at least five (5) days prior to the planned service date to ensure timely notification of coverage approval. Your PCP or specialist is responsible for obtaining authorization. Your PCP or specialist must provide an authorization reference number on all referrals and claims.

Post-Service/Retrospective Review

The Alliance post-service retrospective review is the process that the Alliance Utilization Management (UM) team works with your PCP or specialist to determine medical necessity or coverage under the health plan benefit. Post-service retrospective authorizations will only be considered if submitted within 30 days of the date of service.

At the Alliance, we are here to help. As your partner in health, we strive to connect you to the right care at the right time. If you have a health concern, please call your doctor any time, 24 hours a day, 7 days a week.

Your Doctor

Call your doctor’s office or clinic for advice. Doctors expect to get phone calls at night or on weekends. They set up their practices to receive your calls at times when they are not open. Your doctor can help you decide if you really need to go to the emergency room, or can give you advice about what to do at home that can get you or your child through the night or weekend.

Advice Nurse Line

If you can’t reach your doctor, the nurse line is ready to give you advice, any time, 24 hours a day, 7 days a week.
Please call:

Toll-Free: 1.855.383.7873

Key features of the Advice Nurse Line:

• No cost for Alliance Members.
• Ready to help 24 hours a day, 7 days a week.
• Nurses provide advice on topics, such as:
  • Treatment of common health concerns
  • Tips on leading a healthy lifestyle
  • Health screenings and shots
• Nurses help you decide whether you require emergency or urgent care, or if you should schedule a doctor’s visit.
• Nurses speak English and Spanish, and use interpreters for other languages.
• For more information, please select your preferred language:
  English | Spanish | Chinese

Urgent Care

Your doctor or the advice nurse line may direct you to an urgent care clinic. Many clinics are open late, on weekends and holidays. To find an urgent care clinic in the Alliance network, please search our online Alliance Provider Directory.

To view a copy of the Alliance Group Care Provider Directory, please click here.

As an Alliance member, you have access to behavioral health care services. Prior authorization (approval) is not required for routine outpatient behavioral health care services. The Alliance also covers all substance use disorder (SUD) services.

To find a behavioral health care provider in our network, please click here.

Inpatient Behavioral Health Care and SUD Services

These are services ordered and performed by Alliance for the treatment of an acute phase of a behavioral health and/or SUD condition during a certified confinement in a hospital in the Alliance network.

Benefits include:

• Behavioral Health Crisis Residential Treatment Programs (CRTPs).
• Behavioral health psychiatric hospitalization.
• SUD inpatient detoxification, as medically appropriate to remove toxic substances from the system.
• SUD inpatient services.

Outpatient Behavioral Health Care and SUD Services

These are services used to provide crisis intervention and treatment of alcoholism, drug abuse, or behavioral health on an outpatient basis as medical appropriate.

Office visit benefits include:

• Behavioral health individual and group evaluation and treatment.
• Outpatient monitoring of drug therapy.
• Psychiatric testing/observation.
• Psychological testing.
• SUD individual and group chemical dependency counseling.
• SUD individual and group evaluation and treatment.

Other benefits include:

• Behavioral health multidisciplinary treatment (intensive outpatient psychiatric treatment program).
• Behavioral health treatment for PDD/Autism.
• Opioid replacement therapy.
• SUD intensive outpatient program.
• SUD medication treatment for withdrawal.

To learn more about your benefits and covered services, please view your Alliance Group Care Member Handbook.

As an Alliance Group Care member, dental benefits are provided through Alameda County Public Authority for IHSS.
For more information, please contact:

Alameda County Public Authority for IHSS
Phone Number: 1.510.577.3552
ac-pa4ihss.org

To learn more about your benefits and covered services, please view your Alliance Group Care Member Handbook.

As an Alliance Group Care member, the Alliance covers medical equipment appropriate for use in the home that:

• Is intended for repeated use.
• Is generally not useful to a person in the absence of illness or injury.
• Primarily serves a medical purpose.

To learn more about your benefits and covered services, please view your Alliance Group Care Member Handbook.

As an Alliance Group Care member, eye benefits are provided through Alameda County Public Authority for IHSS.

For more information, please contact:

Alameda County Public Authority for IHSS
Phone Number: 1.510.577.3552
ac-pa4ihss.org

To learn more about your benefits and covered services, please view your Alliance Group Care Member Handbook.

The Alliance wants to help you get health care services and member materials in your preferred language and format.

Our staff can help you find a doctor who speaks your language or make sure you have an interpreter when you need one. We offer interpreter services in your language at no cost to Alliance members, 24 hours a day, 7 days a week. Aids and services for people with disabilities, like documents in braille and large print, are also available.

To learn more, please click here.

Medical transportation services are offered by the Alliance at no cost. There are two (2) types of medical transportation services that are covered under Alliance Group Care.

Emergency Ambulance Services

The Alliance covers ambulance services to help you get to the nearest place of care in emergency situations. This means that your condition is serious enough that other ways of getting to a place of care could risk your health or life. This includes ambulance transportation services provided through the “911” emergency response system.

Authorized Ambulance Services

Ambulance services to transfer a member to or from a participating hospital or skilled nursing facility in connection with an authorized confinement/admission will be authorized only when transportation by other means would adversely affect the member’s medical condition, whether or not such other means of transportation are available.

To learn more about your benefits and covered services, please view your Alliance Group Care Member Handbook.