Please select below to view provider updates from the Alliance.

2023 Provider Satisfaction

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

Urgent Notification: Potential Claim Submission Interruption for Providers Who Use Change Healthcare

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.

Important Notice: Alliance Members May Experience Service Delays Services due to Recent Cyber Security Attack

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 update, please click here.

Important Update: Infusion Codes That Require Authorization

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 more more information regarding this update, please click here.

Initial Health Appointment (IHA)

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.

Important Request: The Alliance Wants You! Join the Alliance Pharmacy and Therapy (P&T) Committee Today

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.

Important Reminder: Claim Submissions by Payor

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.

Important Reminder: Authorization Submission

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.

New Program Announcement: Disease Management Programs (Asthma and Diabetes)

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.

Important Notice: Hospital Notification’s Through Admission Discharge Transfer (ADT) Feed, Starting Thursday, February 1, 2024

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.

2024 Provider Incentive Webinar

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.

Long-Term Care (LTC) Authorization Notifications

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.

Important Notice: California Health and Human Services (CalHHS) Data Exchange Framework (DxF)

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.

New Mandatory Provider Training for Pediatric and Family Medicine Providers – Medi-Cal for Kids & Teens

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.

Dyadic Behavioral Health (DBH) Benefit Information

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.

Important Update for Mental Health Providers: The Mental Health Coordination of Care Update Form is Now Available on the Provider Portal

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.

Important Reminder: Long-Term Care Form Requirements and Updates

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.

The Alliance Will be The Single-Plan Model in Alameda County Starting Monday, January 1, 2024

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.

Transitional Care Services (TCS) Post-Discharge Follow-Up Appointments

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.

Authorization Submission Timeframe and Requirements for Applied Behavior Analysis (ABA) Services & Treatment Plans

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.

HEALTH ADVISORY: Perinatal Hepatitis B Reporting

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

Important Notice for Long-Term Care (LTC) Facilities: Update on Billing and Claims for Rehabilitation Services

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.

Important Announcement: Equity and Practice Transformation (EPT) Payments Program

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.

New and Improved Features and Alliance Mental Health Initial Evaluation Form Now Available on the Provider Portal

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.

Opportunities for PCPs - DHCS Equity and Practice Transformation (EPT) Provider Directed Payment Program

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.

The Alliance is Expanding Enhanced Care Management (ECM) and Community Support (CS) Services

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.

Important Reminder: Continuity of Care (CoC) for Members with Long-Term Care (LTC) is Winding Down

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.

Important Reminder: Billing for Telehealth Services

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.

Utilization Management (UM) Medication (Physician or Facility-Administered Medications/Injections in All Settings) That Require Authorization

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.

Important Reminder: Case Management Programs

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.

Important Reminder: Transportation Benefit for Alliance Long-Term Care (LTC) Members

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.

2023 Quality Measure Highlight Follow-Up After Emergency Department Visit for Substance Use (FUA)

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.

Important Update: Specialty Surgery Codes that Require Authorization

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.

Mobile Mammography

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.

Important Update: Utilization Management (UM) Medication (Physician or Facility-Administered Medications/Injections in All Settings) That Require Authorization

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.

Important Reminder: Transportation for Alliance Long Term Care (LTC) Members

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

Important Update: Specialty Surgery Codes that Require Authorization

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.

Important Update: Medi-Cal Redeterminations are Happening Now. Help Your Patients Keep Their Medi-Cal Coverage

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.

Important: *Updated List* Outpatient Rehab (PT, ST, OT, Cardiac, Pulmonary, and Aquatic) Codes That Require Authorization

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.

Important Update: Preadmission Screening and Resident Review (PASRR) is Required for Skilled Nursing Facility (SNF) Admissions

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.

Important Update: Reconstructive Surgery Codes that Require Authorization

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

Important Provider Reminder for Dialysis Centers: Physician Certification Statement (PCS) Forms are Required for Non-Emergency Medical Transportation (NEMT)

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.

Important Update: Durable Medical Equipment (DME) Codes that Require Prior Authorization (PA)

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.

Important Reminders: For Applied Behavior Analysis (ABA) Providers

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.

Important Reminder: Medi-Cal Rx Transition Policy will be Retired

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.

EFFECTIVE APRIL 1, 2023, ALAMEDA ALLIANCE WILL MANAGE MENTAL HEALTH (MH) AND APPLIED BEHAVIOR ANALYSIS (ABA) SERVICES

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.

Great News! The Alliance is Extending Our Retro Authorization Timeframe

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.

Enhancements to the Online Provider Portal

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.

Preventive Services Guidelines Update

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.

Staying Healthy Assessment To Be Retired in 2023

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.

2022 Population Needs Assessment Report

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.

Important Update: Prosthetic Codes that Require Authorization

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.

Important Provider Reminder: Physician Certification Statement (PCS) Forms are Required for Certain Modes of Transportation

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.

Alliance Contacts for Long-Term Care Benefit Carve-In

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.

Important Reminder: Balance Billing from Contracted Medicare and Medi-Cal Providers is Against the Law

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.

Important Update: AB 1797 Immunization Registry

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.

New Covered Benefit: Community Health Worker (CHW) Services

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.

Important Update: Long-Term Care Benefit Carve-In

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.

Important Update: Orthotic Codes that Require Authorization

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 Virtual Training YOU’RE INVITED!

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.

Important Update: Effective Saturday, December 31, 2022, OptumRx Specialty Pharmacy will no longer be a part of the Alliance Network

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.

Important Update: Podiatry Codes that Require Authorization

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

Important Update: Enteral Nutrition Formula

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.

2022 Seasonal Influenza Vaccines

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.

Important Update: Outpatient Rehab (PT, ST, OT, Cardiac, Pulmonary, and Aquatic) Codes That Require Authorization

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.

Important Notice: New Tertiary-Quaternary (TQ) Process for Alliance Providers and Specialists Referring Members to Academic Centers

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.

Important Update: Continuous Glucose Monitoring (CGM) Devices

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.

Important Update: Starting this July Facility Claims will Require a Discharge Hour

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

Important Notice About Personal Blood Pressure (BP) Cuffs and Monitoring Devices for Medi-Cal Members

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.

Important Reminder to Sign-up and Visit the Medi-Cal Rx Website for Magellan Updates: Drug Utilization Review (DUR) Claim Edit, Reject Code 88 was Reinstated on Friday, July 22, 2022

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.

Reminder: Prior Authorization Requests Marked Urgent

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.

Reminder: Medi-Cal Rx Transition Started Saturday, January 1, 2022

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.

Annual Healthcare Effectiveness Data and Information Set® (HEDIS) medical record data retrieval season

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.

Important Update on New Benefits and Services Starting Saturday, January 1, 2022

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.

Provider Alert: Fraud, Waste & Abuse (FWA) Prevention & Reporting

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.

Important Reminder: Medi-Cal Rx Transition Will Go-Live Saturday, January 1, 2022

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.

Important Update: Hearing Aid and Enteral/Parenteral Codes That Require Authorization

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.

Important Update: Acupuncture, Allergy, Blood Plasma, Sleep Study and Electroencephalogram (EEG) Codes that Require Authorization

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.

Important Follow-up Request for Signed Medical Services Agreements

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.

Important Update: Home Health and Palliative Care Codes That Require Authorization

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.

Important Pharmacy Benefit Administration Changes for Authorization and Claims Payment: Medi-Cal Rx Transition Will Go Live Saturday, January 1, 2022

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.

Important Update: Radiology Codes that Require Authorization

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

Do You Offer Telehealth Appointments?

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.

Important Update: Circumcision, Dialysis, and Genetic Testing Codes that Require Authorization

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.

Important Update: Silicon Valley Medical Imaging Joins Alliance Radiology Network

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.

2021 Seasonal Influenza Vaccines

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.

Important Update on Secondary Claims

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.

2021 Provider Appointment Availability Survey (PAAS) Begins July 12 through December 31, 2021

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.

Important Update: Outpatient Injectable Drug Codes that Require Prior Authorization (PA)

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

Important Update: Continuous Glucose Monitoring Devices

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.

Important Reminder about Transportation Services

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.

Important Update: Radiology Codes that Require Authorization

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

The annual Healthcare Effectiveness Data and Information Set® (HEDIS) medical record data retrieval season is 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.

Phase 1 COVID-19 Vaccine Now Available for All Eligible Alliance Group Care Members

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.

Important Update: Medi-Cal Rx Transition is Postponed Until April 1, 2021 - Provider Portal Training is Available Now

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.

Important Update on Secondary Claims

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.

Stanford Cancer Network Program Partnership

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.

Important Update: For Faster Processing, Please Submit Prior Authorization (PA) Requests Electronically Through the Online Alliance Provider Portal

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.

Important Contracting Update

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

The Alliance now Covers Telephonic Appointments for all Alliance Members.

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.

Important Update: Effective Saturday, August 1, 2020 Alliance Group Care Members will be Responsible for All Copays with the Exception of Copays for COVID-19 Related Screening and/or Testing Services

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.

Alameda Alliance for Health Provider FAQs: COVID-19

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.

Important Update: 2020 Seasonal Flu Vaccine

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.

Important Update: Now Extended through Friday, July 31, 2020 Copays Waived for Alliance Group Care Members

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.

Important Update: For Faster Processing, Please Submit Provider Dispute Resolutions Electronically Starting on Monday, March 30, 2020

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.

Important Update: Flexibility and Reimbursement for Alliance Network Community Based Adult Service (CBAS) Centers

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.

Important Update: Alliance Fax Lines will be Down on Sunday, April 26, 2020 Between 2 pm – 6 pm PST for Scheduled Maintenance

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.

Important Update: Copays Waived for Alliance Group Care Members for care and services related to COVID-19

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.

Alameda Alliance for Health COVID-19 Provider Resource Guide

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

COVID-19 Member Outreach Phone Screening Tool

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.

Important Update: New ICD-10 and HCPCS/CPT Codes to Report Novel Coronavirus Testing and Treatment

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.

Amity Home Health Care, Inc. and Advent Care, Inc. for Home Health and Hospice Authorizations

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.

Proposition 56 (Prop 56)

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.

CalHealthCares Program

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.

Important Update: Coverage of Alternative Modalities

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.

New and Improved Alliance Website and Provider Portal Features

Beginning Monday, March 2, 2020, the Alliance website and online provider portal will have a new look and added features.

For more information regarding this update, please click here.

Important Notice: Our call center will be closing today, Friday, December 11th at 4:50 pm for system upgrade

Notice: Our call center will be closing today, Friday, December 11th at 4:50 pm for system upgrade. We will be unable to receive calls. You may reach us via our Contact Us form or Provider Portal. We will do our best to respond ASAP. Thank you for your patience.

DHCS Expands Medi‐Cal Coverage for Young Adults

On Wednesday, January 1, 2020, a new law in California, called the Young Adult Expansion, gave full scope Medi‐Cal to young adults under the age of 26, regardless of immigration status.

For more information regarding this update, please click here.

Claim Update about Billing Physician Administered Drugs (J, Q and S Codes)

We have updated our billing system to comply with the Medi-Cal requirement to include the National Drug Code (NDC) (Codes that begin with a J, Q or S) when billing for injectable physician administered drugs.

For more information regarding this update, please click here.