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:

Advance Directives

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.

Facility Site Reviews (FSR)

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 assure that each provider meets the Alliance’s standards.

Site reviews are conducted for primary care providers (PCPs) and Obstetric/Gynecological providers during the initial provider credentialing process. Additional PCP site reviews may be conducted every three (3) years as a part of the ongoing re-credentialing process. The reviews includes a site review survey, a medical record review survey, and a physical accessibility review survey assessment.

Resources 

Contact

If you have any questions regarding the site review process, please contact:

HIPAA

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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Provider-Preventable Conditions (PPC)

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:

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.

Provider Portal

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.

Secure Website

Please click here to access the Secure File Transfer Website.