Please select below to view provider updates from the Alliance.

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 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.

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.

Did you know the Alliance Continues to Beat the Benchmarks in Claims Payment?

Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We remain committed to continuously improving our provider satisfaction. 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.

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.

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.

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 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 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.

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: 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 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.

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: 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: 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.

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.

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.

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.

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: 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.

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.

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.

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.

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.

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.

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.