We are here for you. We strive to provide our provider partners with the highest levels of customer service. Every year the Alliance conducts our Provider Satisfaction Survey to help us learn more about what is working and where we can improve to serve you better. For more information regarding this update, please click here.

California State Senate Bill (SB) 923, known as the Transgender, Gender Diverse or Intersex (TGI) Inclusive Care Act, mandates health plans such as the Alliance to include specific provider directory requirements. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) is committed to supporting all providers in meeting the diverse needs of Alliance members and advancing health equity for our members. For more information regarding this important update, please click here.

We are sharing an important announcement for Enhanced Care Management (ECM) and Community Support (CS) providers.
Effective Tuesday, July 1, 2025, all ECM and CS providers must comply with the Department of Health Care Services’ (DHCS) Closed-Loop Referral requirements. For more information regarding this update, please click here.

The Alliance has developed a Diversity, Equity, and Inclusion (DEI) Training Program for providers in accordance with the California Department of Healthcare Services (DHCS) All Plan Letter 24-016 titled Diversity, Equity, and Inclusion Training Program Requirements (previously APL 23-025). The DEI training will be evaluated annually and offered to our provider network each year. For more information regarding this update, please click here.

Billing reminders for LTC Facilities, including Subacute, Custodial, and Intermediate Care Facilities for Individuals with Developmental Disabilities (ICF-DD) Care Providers. For more information regarding this reminder, please click here.

Alameda Alliance for Health (Alliance) is dedicated to working with our providers to ensure our members’ linguistic needs are met. It is important that our members can talk with our providers effectively in the language of their choice. For more information regarding this update, please click here.

This communication provides an update on Utilization Management (UM) Medications physician-administered drugs (PAD) codes that require prior authorization for in-network providers. For more information regarding this update, please click here.

We created a new Applied Behavior Analysis (ABA) Treatment Plan Form for behavioral health providers that now is available in our Alliance Provider Portal. We are excited to work with you directly and offer important training information in using the new form. For more information regarding this update, please click here.

This update affects claims with the date(s) of service starting Monday, February 17, 2025, and onward for the code-specific list of Circumcision, Dialysis, and Genetic Testing codes that require prior authorization. For more information regarding this update, please click here.

We are making technical updates to improve the function of our claims payment system. These updates will improve the accuracy and efficiency of our provider payments. For more information regarding this update, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated provider partner community. We have an important notice to share with you. As part of the California Department of Health Care Services (DHCS) medical audit of the Alliance, DHCS will also conduct random outreach phone calls to interview Alliance contracted providers about the Initial Health Appointment (IHA) process. Outreach phone calls from DHCS to providers in our network will take place between Tuesday, January 7, 2025, through Monday, March 3, 2025. Impacted Alliance providers may include anyone who can administer an IHA, such as primary care, OB/GYN, and behavioral health providers. For more information regarding this update, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated provider partner community. We are sharing an important reminder with you. The California Department of Health Care Services (DHCS) requires managed care plans to implement new Enhanced Care Management (ECM) standardizations, effective Wednesday, January 1, 2025. For more information regarding this update, please click here.

We have an important update we want to share with you about durable medical equipment (DME) codes that require prior authorization. This update affects claims with a service date starting Monday, April 10, 2023, and onward for the code-specific list of DME codes that require prior authorization. The previous notice we shared on Wednesday, March 15, 2023, omitted the following code(s) in error: K0606. For more information regarding this update, please click here.

At Alameda Alliance for Health (Alliance), we appreciate our dedicated provider partner community and strive to deliver the highest levels of service and satisfaction.
We have an important update we want to share with you about Acupuncture, Allergy, Blood Plasma, Electroencephalogram (EEG), and Sleep Study codes that require prior authorization. This update affects claims with a service date starting Monday, February 3, 2025, and onward for the code-specific list of Acupuncture, Allergy, Blood Plasma, EEG, and Sleep Study service procedures. For more information regarding this update, please click here.

The Alliance is committed to growing our network of talented doulas and increasing member access to essential birth support services. This scholarship program is designed to help doulas further their education and training and/or invest in resources to enhance their services. For more information regarding the scholarship program, please click here.

The California Department of Health Care Services (DHCS) covers certain drug classifications carved out from Medi-Cal Managed Care Plans (MCP), including the Alliance. Carved-out drugs must be billed to FFS Medi-Cal. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We have important information to share with you. We previously announced the Alliance is working to launch a new Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) on Thursday, January 1, 2026. Contracting with providers for D-SNP as soon as possible is a vital component of preparing for this launch. For more information regarding this update, please click here.

Effective Sunday, December 1, 2024, the Alliance will upgrade to the 28th edition of the Milliman Care Guidelines (MCG) to learn more about the modules that have been updated, please click here.

We have an important announcement regarding a change in the turnaround time for decisions on inpatient concurrent review. Starting Friday, November 1, 2024, the Alliance will notify providers of decisions within 72 hours of receiving a request with necessary clinical information. To learn more about this change, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated provider partner community. We have important information that we want to share with you regarding Doula services and recommendation form. For more information regarding this update, please click here.

The Alliance is pleased to cover the flu shot for eligible Alliance Group Care and Medi-Cal members. Eligible Alliance members can get a flu shot if supplies are available at your office. For more information regarding this update, please click here. 

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We have an important update about Targeted Rate Increases (TRI) billing that we are sharing with you. For services rendered on or after Monday, January 1, 2024, the Alliance will comply with the TRI minimum fee schedule guidelines per All Plan Letter (APL) 24-007, published by the California Department of Health Care Services (DHCS) on Thursday, June 20, 2024. For more information regarding this update, please click here.

This communication provides an update on the Child Health and Disability Prevention (CHDP) Program Transition starting Monday, July 1, 2024. For more information regarding this update, please click here.

This communication provides an update on Utilization Management (UM) Medications (physician-administered drugs, PAD) codes that require prior authorization for in-network providers. For more information regarding this update, please click here.

To help ensure our members receive timely access to care and to remain compliant with the California Department of Health Care Services (DHCS), we require certain documents to perform our medical necessity review. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) providers and their staff are welcome to join us for a virtual townhall to discuss building and sustaining a quality infrastructure in your clinic. For more information regarding this virtual townhall, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We are sharing urgent information regarding the global Microsoft 365 application outage created by the CrowdStrike disruptions. For more information regarding this update, please click here.

We are excited to let you know the Alliance will launch a new Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) on Thursday, January 1, 2026. For more information regarding this update, please click here.

The California Department of Healthcare Services (DHCS) recently enacted the targeted rate increase (TRI) fee schedule through State Plan Amendment (SPA) 23-0035. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We have an important reminder regarding our DME and supplies vendor. For more information regarding this update, please click here.

QMetrics on behalf of the Alliance will administer the Provider Appointment Availability Survey (PAAS) on an annual basis. All health plans in California are required to survey providers to assess the availability of routine and urgent appointments. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We are sharing this information to invite our contracted Internal Medicine or Family Practice Physicians or psychiatrists to join our Peer Review and Credentialing Committee (PRCC). To learn more about this important committee for our community, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated provider community. We are committed to continuously improving our provider satisfaction.

We are always here for you. We strive to provide the highest levels of customer service to our provider partners. Every year the Alliance conducts a provider satisfaction survey to help us learn how we can serve you better. We use these results to learn what is working and what we need to improve.
When you speak, we listen.

We strive to continue to get better and we want you to know what we have learned and improved. Over the next several weeks we will share key takeaway Did You Know facts with you, and we hope that you will continue to help make us stronger, together.

Week 1: Your Satisfaction Is Our Priority

Week 2: The Alliance has a Dedicated Provider Call Center

Week 3: The Alliance is Beating the Benchmark for Claim Processing

Week 4: The Alliance has Dedicated Provider Relations Representatives

Week 5: We Enhanced our Provider Online Provider Portal

Week 6: The Alliance is here to Partner with our Providers to Improve Health Outcomes

Week 7: The Alliance Supplies Interpreter Services at No Cost to Alliance Members

Week 8: In 2022, The Alliance Sent Over 300 Care Books with Health Education Info. to Members

Week 9: Since April 1, 2023, The Alliance Insourced the Administration of Behavioral Health Services

Week 10: The Alliance Received over 91,000 Requests for Authorization Last Year

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We have an important reminder that we would like to share with you. To help ensure the safety of our members and compliance with the California Department of Health Care Services (DHCS) California Advancing and Innovating Medi-Cal (CalAIM) Population Health Management Policy Guide, all members must receive transitional care services when moving from one setting or level of care to another. For more information regarding this update, please click here.

Our provider partner satisfaction is a top priority. We are working to improve our Utilization Management and Claims processes to help ensure proper claim payment to our provider partners, and alignment of authorized services. To accomplish this goal, we are reviewing each benefit and we will be sending you updates, as the information is ready to share. This communication provides an update on Utilization Management (UM) Medications (physician-administered medications) codes that require prior authorization, effective Monday, June 3, 2024.

For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our provider partner community and appreciates all your hard work to protect the health and well-being of our members. We have an important update that we would like to share with you. Starting Monday, July 1, 2024, Alliance Medi-Cal members who require Continuous Glucose Monitoring (CGM) devices and supplies will need a prior authorization (PA) from Medi-Cal Rx.

For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We are sharing urgent information regarding a potential network interruption for Change Healthcare claims submissions. On Wednesday, February 21, 2024, the Alliance received notification that our vendor, Change Healthcare experienced a cyber security attack. We took immediate action to disconnect data exchange systems to prevent further impact. We continue to monitor the situation. For information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We have an important update that we would like to share with you.
In 2023, the MCG 27th guidelines changed for common ear, nose, and throat (ENT) surgeries like turbinate resection and septoplasty.

For information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We are sharing an important update for our provider partners requesting authorization for Home Health services and Home Health agencies.
The Alliance aims to process authorizations for medically necessary Home Health services routine and urgent requests following our regulatory prior authorization processing time.

For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our provider network. We are dedicated to working with our providers, members, and the community to improve our services and programs.
Alliance members have the right to authorize (give) a friend, family member, or another person they identify to assist them with the coordination of their care.

For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. Welcome to a new HEDIS measurement year 2024! As we plan for another successful year, we want to share a brief reminder on the measures we track and recommendations for focused timing. For more information regarding this update, please click here.

Our provider partner satisfaction is a top priority. We are working to improve our Utilization Management and Claims processes to help ensure proper claim payment to our provider partners, and alignment of authorized services. This communication provides an update on Hospice procedure or revenue codes that require prior authorization. For more information regarding this update, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated provider partner community and appreciate all the hard work you do to protect health and wellbeing. We are sharing this notice to inform you about an important update regarding the Alliance vendor Change Healthcare / Optum. For more information regarding this notice, please click here.

Our provider partner satisfaction is a top priority. We are working to improve our Utilization Management and Claims processes to help ensure proper claim payment to our provider partners, and alignment of authorized services. This communication provides an update on infusion codes that require prior authorization. For information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We are sharing urgent information regarding a potential network interruption for Change Healthcare claims submissions. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community, and we are here for you. We are sharing the Alliance Initial Health Appointment Provider Guide to share an overview of the requirements and best practices. To access this guide, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We are sending information to invite our contracted Internal Medicine or Family Practice Physicians or psychiatrists to participate on our Pharmacy and Therapeutics (P&T) Committee. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We are sharing important reminders as they relate to claims and billing processes. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We are sharing important reminders as they relate to requests for authorizations. For more information regarding this update, please click here.

The Alliance is honored to provide asthma and diabetes disease management programs to our members as a part of our Medi-Cal and Group Care benefits. For more information regarding this update, please click here.

The Alliance currently receives admission notifications (face sheets) via fax when a member is admitted to a hospital. We also receive Admission Discharge Transfer (ADT) feeds, a hospital data feed that provides similar information. For more information regarding this update, please click here.

Primary care providers (PCPs) and their staff are welcome to join our webinar to discuss the Alameda Alliance for Health (Alliance) 2024 Pay for Performance (P4P) Program. For more information on the webinar and how to RSVP, please click here.

As the Alliance closes out our first year of managing the essential long-term care (LTC) benefit for our members, we are retrospectively reviewing our records to help ensure they accurately reflect the members residing in your facility. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We have an important update to share with you about the California Health and Human Services (CalHHS) Data Exchange Framework (DxF).

The CalHHS DxF is a statewide data-sharing agreement (DSA) working to accelerate and expand health information exchanges between health care entities, government agencies, and social service programs beginning in January 2024. For more information regarding this update, please click here.

Alliance contracted pediatric and family medicine providers must complete the new Medi-Cal for Kids & Teens Provider Training developed by the California Department of Healthcare Services (DHCS). For more information regarding this update, please click here.

We have an important update on the dyadic behavioral health (DBH) benefit for Alliance Medi-Cal members. For more information regarding this update, please click here.

We are excited to announce that we have updated the features on our Alliance Provider Portal to include the Mental Health Coordination of Care Update Form. For more information regarding this update, please click here.

The Alliance utilizes several forms to help ensure we appropriately authorize all medically necessary services for our Long-Term Care (LTC) members. For more information regarding this update, please click here.

On Monday, January 1, 2024, Alameda County will change its Medi-Cal Managed Care model from a two-plan model (Anthem and the Alliance) to a single-plan model (the Alliance). This means Anthem (the exiting plan) will no longer be a Medi-Cal managed care option in Alameda County. For information regarding this update, please click here.

The Alliance is honored to provide Transitional Care Services (TCS) to our members as a part of our Medi-Cal and Group Care benefits. For more information regarding this update, please click here.

All providers must submit all Applied Behavior Analysis (ABA) progress reports two (2) weeks before the ABA service authorization ends. For more information regarding this update, please click here.

For more information regarding the Alameda County Public Health Department Perinatal Hepatitis B reporting, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated LTC provider partner community. We have an important notice that we would like to share with you. For more information regarding this update, please click here.

The Department of Health Care Services (DHCS) is implementing a one-time $700M primary care provider practice transformation program called the Equity and Practice Transformation (EPT) Payments Program. The program is designed to advance health equity, reduce COVID-19-driven care disparities, and prepare practices to participate in alternative payment models. For more information regarding this update, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated provider community. We are excited to announce that we have updated the features on our Alliance Provider Portal and reinstated the Mental Health Initial Evaluation Form. For more information regarding this update, please click here.

The Alliance would like to share information sent to us by the Department of Health Care Services (DHCS).

DHCS is excited to launch the Equity and Practice Transformation (EPT) Provider Directed Payment Program. The program will provide primary care practices the opportunity to get funding opportunities to complete practice transformation activities which advance health equity and population health.  The application and guidelines will be posted to the EPT website.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. As part of the state’s CalAIM initiative, we have an exciting update about the Alliance’s expansion of Enhanced Care Management (ECM) and Community Supports (CS) that we want to share with you. For information regarding this update, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated provider community and the relationships with our provider  partners in caring for our members in Long-Term Care (LTC) settings. We have an important update about the Department of Health Care Services (DHCS)-mandated Continuity of Care (CoC) period ending for both members in facilities and for external services provided to members while in facilities. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We appreciate the access to care and  services you continue to provide via in-person and telehealth visits. We are sharing an important reminder about Medi-Cal billing requirements for telehealth services and newly established criteria to provide services via telehealth. For more information regarding this update, please click here.

This communication provides an update on Utilization Management (UM) Medications (including physician or facility administered medications/injections in all settings) codes that require prior authorization. This does not include outpatient pharmacy services through the member’s pharmacy benefit. For more information regarding this update, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated provider community. We have an important reminder that we want to share with you about our Case Management Programs. For more information regarding this update, please click here.

The Alliance is pleased to contract with Modivcare to provide transportation services for our members. Together, we look forward to working with our skilled nursing facilities (SNFs) partners to ensure Alliance members in long-term care (LTC) who transitioned from traditional Medi-Cal fee-for-service (FFS) to Medi-Cal managed care receive the highest quality of care. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community, and we are here to help you. We are sharing the 2023 Quality Measure Highlight: Follow-Up After Emergency Department Visit for Substance Use (FUA) to provide a snapshot of the Healthcare Effectiveness Data and Information Set® (HEDIS®) technical specifications and suggested best practices to help meet the measure. For more information regarding this update, please click here.

Our provider partner satisfaction is a top priority. We are working to improve our Utilization Management and Claims processes to help ensure proper claim payment to our provider partners and alignment of authorized services. For more information regarding this update, please click here.

At Alameda Alliance for Health (Alliance), we are here to help our members take charge of their health. We are looking to partner with provider locations to host mobile mammography services to increase breast cancer screening rates for Alliance providers. For more information regarding this update, please click here.

This communication provides an update on Utilization Management (UM) Medications (including physician or facility-administered medications/injections in all settings) codes that require prior authorization. This does not include outpatient pharmacy services through the member’s pharmacy benefit. This will affect claims with the date(s) of service starting Friday, September 1, 2023, and onward. For more information about this update, please click here.

The Alliance is pleased to contract with Modivcare to provide transportation services for our members. To learn more, please click here.

This communication provides an update on specialty surgery codes that require prior authorization. This will affect claims with the date(s) of service starting Tuesday, August 1, 2023, and onward. For more information regarding this update, please click here.

Over the last three years, Medi-Cal beneficiaries have stayed enrolled in the Medi-Cal program under the continuous coverage requirement enacted during the COVID-19 Public Health Emergency.

On Friday, March 31, 2023, the continuous coverage requirement ended, and the annual process to review eligibility for coverage was reinstated, for all Medi-Cal beneficiaries.

Starting now through Sunday, June 30, 2024, all Medi-Cal beneficiaries must be renewed to stay enrolled in the program. The Alliance will work with our providers and community partners to help support our members through this process. For more information regarding this update, please click here.

This communication provides an update on Outpatient Rehab (PT, ST, OT, Cardiac, and Aquatic) codes that require prior authorization (PA). For more information regarding this update, please click here.

Effective Monday, May 1, 2023, the California Department of Health Care Services (DHCS) requires the Alliance to obtain and review Preadmission Screening and Resident Review (PASRR) documentation as a part of the prior authorization request and review process. The Alliance must also confirm the completion of the PASRR before approving the stay. For more information regarding this update, please click here.

This communication provides an update on reconstructive surgery codes that require prior authorization. For more information regarding this update, please click here.

The Alliance is proud to provide transportation services to our members as a part of our Medi-Cal and Group Care benefits. Alliance Medi-Cal members can also receive non-emergent medical transportation (NEMT) for specific modes of medical transportation. A Physician Certification Statement (PCS) is needed from the member’s provider with a detailed assessment of the patient’s medical needs or functional limitations that require NEMT. Dialysis providers can complete the PCS Form for Alliance members to receive NEMT. For more information regarding this update, please click here.

This communication provides an update on durable medical equipment (DME) codes that require prior authorization (PA). This will affect claims with the date(s) of service starting Monday, April 10, 2023, and onward. To learn more, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We are excited to work with you directly and provide important information as we insource behavioral health and mental health services. For more information regarding this update, please click here.

Starting on Friday, March 24, 2023, Medi-Cal Rx will begin a series of transition policy lifts for Medi-Cal beneficiaries 22 years of age and older. For more information regarding this update, please click here.

Alameda Alliance has upcoming Provider Orientation and Trainings on the following dates:

• Mental Health Providers: Thursday, March 16, 2023 and Thursday, March 23, 2023. For more information regarding this training and to RVSP, please click here.
• ABA Providers: Tuesday, March 14, 2023 and Tuesday, March 21, 2023. For more information regarding this training and to RVSP, please click here.

Effective Wednesday, March 1, 2023, our retro review process timeframe for when a provider can submit a request – will be extended from 30 days to 90 days post the date of service for non-emergent or non-urgent services. For more information regarding this update, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated provider community. We are excited to announce that we are upgrading our online Provider Portal features. To improve claim processing and payment, we are adding a professional claims submission process through the Alliance Provider Portal. For more information regarding this update, please click here.

At the Alliance, we require that all network and delegated providers follow the most current Preventive Care Guidelines. For more information regarding this update, please click here.

On January 1, 2023, DHCS retired the existing requirements for the IHEBA/SHA, namely the prescribed questionnaires to be used at these initial visits and intervals thereafter. For more information regarding this change, please click here.

Alameda Alliance for Health develops a Population Needs Assessment (PNA) with the goal of improving health outcomes and ensuring that the Alliance and its provider partners are meeting the needs of all its Medi-Cal members. For more information regarding this update, please click here.

Our provider partner satisfaction is a top priority. We are working to improve our Utilization Management and Claims processes to help ensure proper claim payment to our provider partners, and alignment of authorized services. To accomplish this goal, we are reviewing each benefit and we will be sending you updates, as the information is ready to share. This communication provides an update on prosthetic codes that require prior authorization (PA). This will affect claims with the date(s) of service starting Friday, February 10, 2023, and onward. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We have an important reminder we would like to share with you. The Alliance is honored to provide transportation services to our members as a part of our Medi-Cal and Group Care benefits. For more information regarding this reminder, please click here.

Starting on Sunday, January 1st, 2023, the long-term care (LTC) benefit will be administered by the Alliance as a part of the statewide California Advancing and Innovating Medi-Cal (CalAIM) goal to standardize benefits and reduce complexity and county-to-county differences across the state. For a breakdown of the LTC benefit administration change and key Alliance contacts, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We have an important reminder from the California Department of Health Care Services (DHCS) to share with you.

The Social Security Act and California Welfare and Institutions Code prohibit contracted providers from balance billing Medi-Cal beneficiaries. Alliance Medi-Cal members and Medi-Cal beneficiaries cannot be charged for co-pays, co-insurance, or deductibles when they receive covered care and services from a provider in their provider network. This law applies to all Medicare and Medi-Cal providers. For more information about this important reminder, please click here.

Assembly Bill 1797 (AB 1797) was signed by Governor Newsom to update the current immunization registry statute. For more information regarding this update, please click here.

Effective Friday, July 1, 2022, community health worker (CHW) services became a new Medi-Cal covered benefit. According to the California Department of Health Care Services (DHCS), CHW services are preventive health services designed to prevent disease, disability, and other health conditions or their progression; prolong life, and promote physical and mental health. For more information regarding this benefit, please click here.

Starting on Sunday, January 1st, 2023, the long-term care (LTC) benefit will be administered by the Alliance as a part of the statewide California Advancing and Innovating Medi-Cal (CalAIM) efforts to standardize and reduce complexity and county-to-county differences across the state. For more information regarding this update, please click here.

This communication provides an update on orthotic codes that require prior authorization (PA). For more information regarding this update, please click here.

Long-term care (LTC), skilled nursing facility (SNF), and sub-acute providers are welcomed to join our virtual training to discuss the LTC integration into the Alliance, starting on Sunday, January 1, 2023. For more information regarding the upcoming training dates, please click here.

Effective Saturday, December 31, 2022, OptumRx Specialty Pharmacy will no longer be in the Alliance pharmacy network, and PerformSpecialty will be our new in-network specialty pharmacy. For more information regarding this update, please click here.

This communication provides an update on podiatry codes that require prior authorization (PA). For more information regarding this update, please click here.

Starting Saturday, January 1, 2022, enteral nutrition formula became a Medi-Cal Rx pharmacy benefit for Alliance members with Medi-Cal coverage. Effective Thursday, December 1, 2022, the Alliance will no longer cover or review authorization requests for enteral nutrition formulas for Alliance Medi-Cal members. For additional information regarding this update, please click here.

Effective Thursday, September 1, 2022, the Alliance will reimburse providers for administering the Alliance formulary injectable seasonal flu vaccine to eligible Alliance Group Care and Medi-Cal members. The flu vaccine is available at no cost to eligible Alliance members. For more information regarding this update, please click here.

Outpatient Rehab (PT, ST, OT, Cardiac, and Aquatic) codes that require prior authorization (PA). This will affect claims with date(s) of service starting Monday, September 26, 2022, and onward. For more information regarding this update, please click here.

Starting Saturday, October 1, 2022, the new Alliance Tertiary-Quaternary (TQ) Policy will be implemented to help standardize the process for reviewing referrals and transitions to tertiary and quaternary centers. For more information regarding this update, please click here.

Starting Thursday, September 1, 2022, Alliance members who require Continuous Glucose Monitoring (CGM) devices will need prior authorization (PA) from the responsible entity. For more information regarding this update, please click here.

We want to share an important claim process update for Alliance members. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We have an important update we would like to share with you regarding personal blood pressure (BP) cuffs and monitoring devices. For more information regarding this update, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated provider partners and appreciate all the hard work you do to protect health and wellbeing in our community. We have an important update we would like to share with you on behalf of the Medi-Cal Rx pharmacy benefit contractor, Magellan Medicaid Administration, Inc. (Magellan). For more information regarding this update, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated provider partner community. We would like to share an important reminder related to prior authorization (PA) requests that are marked urgent. For information regarding this reminder, please click here.

A new pharmacy benefit contractor, Magellan Medicaid Administration, Inc. (Magellan), started providing services and support on Saturday, January 1, 2022. The new program is called “Medi-Cal Rx.” The Alliance is no longer the administrator for the Medi-Cal pharmacy benefit.

We have put together a list of updates to provide frequently requested information about the change. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) staff may contact your office each year to verify the HEDIS® contact information, arrange a time to collect medical records, or to request that medical records be faxed or mailed. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We have an important CalAIM update that we would like to share with you. CalAIM is a statewide California Department of Health Care Services (DHCS) multi-year initiative that builds upon the Whole Person Care (WPC) Pilot and Health Homes Program (HHP). It is designed to implement a broad delivery system, program, and payment reform across the Medi-Cal program with the ultimate long-term goal of a better quality of life for all Medi-Cal members.

Effective, Saturday, January 1, 2022, the existing HHP will transition to Enhanced Care Management (ECM) and we will also begin to offer six (6) Community Supports (CS) services. For more information regarding this update, please click here.

Effective Saturday, January 1, 2022, the Department of Health Care Services (DHCS) will change how the Medi-Cal pharmacy benefit is administered and a new pharmacy benefit contractor, Magellan Medicaid Administration, Inc. (Magellan), will provide services and support. For more information regarding this update, please click here.

At the Alameda Alliance for Health (Alliance), we are committed to building and maintaining our valuable community and provider partnerships. In support of those relationships, the Alliance promotes the prevention, detection, and resolution of fraud, waste and abuse (FWA), and other unlawful activities in and around healthcare. For more information regarding this update, please click here.

Effective Saturday, January 1, 2022, the Department of Health Care Services (DHCS) will change how the Medi-Cal pharmacy benefit is administered and a new pharmacy benefit contractor, Magellan Medicaid Administration, Inc. (Magellan), will provide services and support. For more information regarding this update, please click here.

This communication provides an update on Hearing Aid and Enteral/Parenteral codes that require prior authorization (PA). These codes will require a PA starting Monday, December 13, 2021, and onward. For more information regarding this update, please click here.

This will affect claims with date(s) of service starting, Monday, August 2, 2021, and onward. Enclosed with this notice is a code-specific list for Acupuncture, Allergy, Blood Plasma, Sleep Study and EEG codes that shows which codes require PA. For more information regarding this update, please click here.

The Alliance sent a new Medical Services Agreement for both Medi-Cal and Alliance Group Care lines of businesses. The updated Medical Services Agreement will replace your current Medi-Cal and Alliance Group Care Agreements. For more information regarding this update, please click here.

This communication provides an update on home health and palliative care codes that require prior authorization (PA). These codes will require a PA starting Monday, December 6, 2021, and onward. For more information regarding this update, please click here.

Effective Saturday, January 1, 2022, the Department of Health Care Services (DHCS) will change how the Medi-Cal pharmacy benefit is administered and a new pharmacy benefit contractor, Magellan Medicaid Administration, Inc. (Magellan), will provide Medi-Cal Rx services and support. The Alliance will no longer be the administrator for the Medi-Cal pharmacy benefit. All providers will be required to use the Medi-Cal Rx Portal beginning Saturday, January 1, 2022, to submit certain authorizations and receive payment for these claims. The new program will be called “Medi-Cal Rx.” For information regarding this update, please click here.

This communication provides an update on the radiology codes that require authorization. For more information regarding this update, please click here.

To help us better understand how, or if, our providers are offering alternative modalities to in-person visits, we are asking you to complete our short online survey about telehealth. For more information regarding this survey, please click here.

This communication provides an update on circumcision, dialysis, and genetic testing codes that require prior authorization (PA). For more information regarding this update, please click here.

Effective Wednesday, September 1, 2021, the Alliance will be contracted with Silicon Valley Medical Imaging for radiology services. For more information regarding this update, please click here.

The Alliance is pleased to offer coverage of the flu shot. All eligible Alliance Medi-Cal and Group Care members can now get a flu shot if supplies are available at your office. For more information regarding this update, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated provider partner community. We have an important update that we would like to share with you about the claim process for members with primary Medicare coverage. For more information regarding this update, please click here.

Each year, the Alliance conducts its annual Provider Appointment Availability Survey (PAAS). All health plans in California are required to survey providers to assess the availability of routine and urgent appointments. For more information regarding this update, please click here.

This communication provides an update on Outpatient Injectable Drug codes that require prior authorization (PA). Please click here for more information.

Effective Saturday, May 1, 2021, prior authorization (PA) requests for eligible Alliance members who require Continuous Glucose Monitoring will need to be submitted to California Home Medical Equipment (CHME), our durable medical equipment vendor. Please click here for more information.

The Alliance provides transportation benefits to Medi-Cal members for all medically necessary services covered by the Alliance and Medi-Cal. For more information regarding this update, please click here.

This communication provides an update on Radiology codes that require prior authorization (PA) starting Thursday, April 1, 2021. To learn more please click here.

As a reminder, Alameda Alliance for Health (Alliance) staff may contact your office each year to verify the HEDIS® contact information, arrange a time to collect medical records, or to request that medical records be faxed or mailed. For more information regarding this update, please click here.

Alameda County Public Health (ACPHD) has contracted with Community Health Center Network (CHCN) to administer the COVID-19 vaccine for all eligible Alliance Group Care members. For more information regarding this update, please click here.

The California Department of Health Care Services (DHCS) is postponing the transition of pharmacy services, also known as Medi-Cal Rx, to Thursday, April 1, 2021. For more information regarding this update, please click here.

The Alliance is participating in the Coordination of Benefits Agreement (COBA) with Medicare starting October 30, 2020, and we will begin to receive crossover claims directly from Medicare for members who have Medicare as their primary coverage. For more information regarding this update, please click here.

Alameda Alliance for Health (Alliance) is thrilled to announce our new partnership with Stanford Medicine and Stanford Health Care’s University HealthCare Alliance (UHA) Cancer Network Program. This partnership will allow Alliance members with oncologic or hematologic diagnoses to have access to Stanford Cancer Network specialists through both in-person and virtual visits. For more information regarding this update, please click here.

Effective immediately, we strongly advise providers to submit Prior Authorization (PA) Requests electronically, through the Alliance Provider Portal. As a number of our operations have been transitioned to be performed remotely, we are able to process PA forms that are submitted electronically more quickly, than PA forms that are submitted by fax. For more information regarding this update, please click here.

The Alliance Provider Contracting Department has updated its contract agreement templates for network contracted providers. For more information regarding this update, please click here.

Effective Monday, March 16, 2020, through Tuesday, June 30, 2020, the Alliance will cover telephonic appointments for all eligible Alliance members. To learn more, please click here.

Effective, Saturday, August 1, 2020, copays for applicable care and services will resume, and return to the standard process. This applies to all services where the purpose of the visit is NOT related to screening and/or testing for COVID-19. For more information regarding this update, please click here.

At Alameda Alliance for Health (Alliance), we value our dedicated provider partner community and appreciate all of your hard work on the frontlines of the COVID-19 pandemic. We have created FAQs to help address questions you may have regarding resources you can offer your patients during the Shelter-in-Place Order by the Alameda County Public Health Department (ACPHD). To view the FAQs, please click here.

The Alliance is pleased to offer coverage of the flu shot. All eligible Alliance Medi‐Cal members between the ages of 19 to 64 years old, and Alliance Group Care members of any age can now get a flu shot if, and when supplies are available and offered at your office. To learn more, please click here.

Effective, Monday March 16, 2020, the Alliance will waive the member’s copayment responsibility and include the copayment amount in our reimbursement, will now be extended until Friday July 31, 2020. For more information regarding this update, please click here.

Effective Monday, March 30, 2020, we are strongly advising providers to begin submitting Provider Dispute Resolution (PDR) forms electronically through the Alliance Provider Portal or secured email. For more information regarding this update, please click here.

For information regarding this update, please click here.

• CDC High Risk Fact Sheet
• CDC Phone Call Guidance
• CDC COVID-19 Fact Sheet
• SAMHSA Coping with Stress

Effective Monday, March 16, 2020, CBAS Centers will have the flexibility to administer day-center activities using alternative modalities and settings, to support the ongoing statewide efforts to prevent the spread of coronavirus (COVID-19). For more information regarding this update, please click here.

On Sunday April 26, 2020, our fax lines will be down between 2 pm through 6 pm PST, for a scheduled upgrade. For more information regarding this update, please click here.

The Alliance is waiving all copayments for care and services related to COVID-19 for Alliance Group Care Members. For information regarding this update, please click here.

To access the Alameda Alliance for Health COVID-19 Provider Resource Guide, please click here.

Please use the COVID-19 Member Outreach Phone Screening Tool to assist you during member outreach calls. The tool consists of questions you can ask the Alliance member over the phone to assess if they are experiencing any health and/or social concerns due to COVID-19. To access the tool, please click here.

Effective, Thursday, March 26, 2020, the Alliance has implemented the following changes to our claims system in accordance with state and federal guidance to track novel coronavirus testing and treatment in our community. For more information on this update, please click here.

Effective, Wednesday, January 1, 2020, the Alliance will no longer have a contract with Amity Home Health Care, Inc. or Advent Care, Inc. for home health and hospice services.

For more information regarding this update, please click here.

Alameda County Health Care Services Agency – Novel Coronavirus Health Update
CDC Health Update – Update and Interim Guidance on Outbreak of 2019 Novel Coronavirus (2019-nCoV)
CDC – Flowchart to Identify and Assess 2019 Novel Coronavirus

Adverse Childhood Experiences (ACEs) Trauma Screening, Behavioral Health Integration (BHI) Incentive Program, CalHealthCares Program, Developmental Screenings, Enhanced Directed Payments for Physician Services, Family Planning Access Care and Treatment (PACT) Services, and Value-Based Payment (VBP) Program.

For more information regarding this update, please click here.

In an ongoing effort to improve health throughout our state and community, the California Department of Health Care Services (DHCS) has partnered with Physicians for a Healthy California (PHC) to create the CalHealthCares Program.

For more information regarding this update, please click here.

Effective immediately, all Alliance contracted providers billing for video, telephone and telehealth appointments, may ONLY use CPT codes for an office visit with the appropriate place of service and/or modifier codes, regardless of the modality. For more information regarding this update, please click here.