The Alliance contracts with California Home Medical Equipment (CHME) for authorization management and servicing for the majority of DME services to all members in all medical groups.

CHME manages the following service categories:

  • Find doctors and get appointments
  • Breast pumps
  • Home respiratory equipment
  • Hospital beds
  • Incontinence supplies
  • Nutritional supplements and feeding supplies
  • Wheelchairs, walkers, and canes
  • Other home medical supply needs

Prior authorization (PA) requests for DMEs should be directed to CHME for processing.

For services excluded from CHME’s management, the Alliance contracts with a select group of providers. Providers should submit PA request directly to the Alliance UM Department for these excluded services for all members in all medical groups. A list of services excluded from CHME and preferred alternate vendors can be available through the Alliance UM Department.

For the most up to date information or if you have questions, please call:

Alliance Utilization Management Department
Monday – Friday, 8 am – 5 pm
Phone Number: 1.510.747.4540 ext. 5
Fax: 1.855.891.7174

For a complete list of services that require authorizations, and the corresponding Alliance Utilization Management (UM) processor, please view the Alliance Referral and Prior Authorization (PA) Grid for Medical Benefits (for directly contracted providers only). The list will indicate the corresponding UM processor for each service at the procedure code level.

Prior Authorization (PA) Requirement

All new and renewal DME services still require prior authorization and will be reviewed by CHME or the Alliance UM Department. Whether an authorization is reviewed by CHME or the Alliance is based on the HCPC code.

The Alliance can only authorize medical supply items not available through CHME to a select group of vendors. Please submit orders to a designated vendor as specified for each item category. Otherwise, the Alliance UM Department will modify the provider’s request to a preferred vendor.

Effective November 1, 2014, DME services managed by CHME are excluded from the Alliance’s retrospective authorization policy which allows for authorization submission up to 30 days after the date of service. The Alliance will not grant an authorization for these services unless the service was rendered for an emergency medical condition, the emergency need is explained, and the authorization request is clearly marked “RETRO.” These requests will be reviewed on an individual case basis. The Alliance will issue an administrative denial for retrospective authorizations which do not meet these requirements.

Failure to obtain a prior authorization for DME services by the servicing provider (unless the service was rendered for an emergency medical condition) will result in claim non-payment and will become the provider’s liability. As the claim is non-payable due to provider non-compliance, this will not be considered a “Non-Covered Service”. Our members may not be balanced billed in these situations, whether or not a “member consent form” for Non-Covered Services has been signed.

Initiating an Authorization

Authorization requests should be submitted to either the Alliance or CHME through the contact numbers below using the standard Alliance Prior Authorization (PA) Request Form. Providers can also obtain status updates on a submitted authorization using the numbers below. Both CHME and the Alliance are open for phone calls Monday – Friday, 8:30 am – 5 pm.

Method of Submission

For Services Provided and Managed by CHME

For Services Not Provided by CHME and Managed by the Alliance
Phone 1.800.906.0626

1.650.357.8550

 1.510.747.4540
Fax 1.844.583.4049

1.650.523.4508

 1.855.891.7174
Email To submit authorizations:
aaorders@chme.orgFor questions:
aaquestions@chme.org		 To submit please log on to your Alliance Provider Portal account.
Online Coming soon… To submit please log on to your Alliance Provider Portal account.

The following minimum information will be required to initiate an authorization:

  • Patient information
    • Name
    • Address and phone number
    • Date of birth
    • Member Identification number
  • Ordering provider information
    • Name
    • Address and phone number of practice
    • National Provider Identification (NPI)
  • Requested HCPC code(s) and name(s)
  • Diagnosis code(s)
  • Any clinical information pertaining to the requested service

An authorization/notification number, along with any quantity or date limits, will be given for all authorizations that are consistent with evidence-based clinical guidelines.