Member Grievances & Appeals

If you become aware of a member with a problem or complaint about the Alliance, its policies, or its providers, please give the member the Alliance Grievance Form. For more detailed information regarding the process, please view our Grievances & Appeals page.

If the Alliance member would like to receive member materials in another language, please 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

Alameda Alliance Wellness Member Services Department
Monday –  Sunday, 8 am –   8pm, including holidays
Toll-Free: 1.888.88A.DSNP (1.888.882.3767)
People with hearing and speaking impairments (CRS/TTY): 711/1.800.735.2929

Provider Grievances & Appeals

Grievances

If you do not agree with the processing or non-payment that is not related to a claim, you may request to file a provider grievance by contacting:

Mailing Address:

Alameda Alliance for Health
ATTN: Alliance Provider Services Department
PO Box 2818
Alameda, CA 94501-0460

Appeals

If the Peer Review & Credentialing Committee (PRCC) recommends an adverse decision based on medical quality concerns of an initial application or re-credentialing that result in a mandatory reportable action, the practitioner will be notified in writing of this decision. The practitioner has the right to request a hearing before a Judicial Review Committee (JRC) within 30 days of receipt of the PRCC notification. A provider who wishes, and is eligible, to file an appeal of an adverse credentialing or participation decision must deliver a written notice requesting a fair hearing before the JRC to the Alliance Chief Medical Officer within the time period specified.

The following procedures are followed for a Judicial Review process:

  • Fair Hearings shall be brought before a JRC for review and recommendation.
  • Notice will be given to the provider stating the date of the JRC and the provider shall have an opportunity to present their position.
  • The decision of the JRC will be sent to the PRCC and the practitioner.
  • The JRC will issue a written decision which shall include findings of fact and a conclusion within 30 calendar days after final adjournment of the hearing.