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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.
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.
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.
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
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:
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.
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