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.

Los centros de atención primaria de la red de la Alianza se revisan como una condición de participación en la red de la Alianza. El propósito de estas revisiones es cumplir con los estándares de mejora de la calidad y asegurar el cumplimiento de las leyes y regulaciones locales, estatales y federales aplicables. Las revisiones del sitio aseguran que cada proveedor cumpla con los estándares de la Alianza.

Las revisiones del sitio se llevan a cabo para proveedores de atención primaria (PCP) y proveedores obstétricos/ginecológicos durante el proceso inicial de credencialización del proveedor. Se pueden realizar revisiones adicionales del sitio del PCP cada tres (3) años como parte del proceso de re-credencialización en curso. Las revisiones incluyen una encuesta de revisión del sitio, una encuesta de revisión de registros médicos y una evaluación de la encuesta de revisión de accesibilidad física.

Recursos (próximamente)

• Carta de todo el plan de DHCS
• Encuesta de revisión del sitio de la instalación de DHCS
• Encuesta de revisión de registros médicos de DHCS
• Carta de política de DHCS MMCD 14-004
• Encuesta de Revisión de Accesibilidad Física de DHCS
• Lista de verificación de FSR/MRR

Contacto

Si tiene alguna pregunta con respecto al proceso de revisión del sitio, póngase en contacto con:

• 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.