2025 CBI data submission: what you need to know
The deadline to submit your 2025 Care-Based Incentive (CBI) data is Feb. 28, 2026. The Data Submission Tool (DST) is available on the Alliance’s Provider Portal under “Data Submissions.” This tool allows providers to submit data from their electronic medical records and paper records for the CBI and Healthcare Effectiveness Data and Information Set (HEDIS) measures.
A Data Submission Tool Guide is also available on the Portal. This guide provides step-by-step instructions on the information required for each measure, how to upload and how to correct rejections.
Measures
Measures you can submit data for include:
- Breast Cancer Screening (screening and mastectomies).
- Cervical Cancer Screening (Pap and HPV screenings and hysterectomies).
- Child and Adolescent Well-Care Visits (0-21 years).
- Chlamydia Screening.
- Colorectal Cancer Screening.
- Controlling High Blood Pressure.
- Depression Screening for Adolescents and Adults.
- Developmental Screening in the First 3 Years.
- Diabetic HbA1c Poor Control >9.0%.
- Application of Dental Fluoride Varnish.
- Immunizations for Children and Adolescents.
- Initial Health Appointment (IHA).
- Lead Screening in Children.
- Post-Discharge Care.
After you submit your data, you will receive an email confirmation within one business day.
Tips for successful submission
- Submissions for Well-Child Visits in the First 15 Months of Life (W15) must be made under the baby’s ID number. If the baby has not been assigned an ID number, please wait to submit measure data until the baby’s ID is available. This will help ensure accurate reporting and proper attribution for the measure.
- For Initial Health Appointment (IHA) reporting, IHA “dummy code” (99499) submissions must be submitted via the Data Submission Tool (DST). The Provider Portal includes the dummy code submission that providers can use after three unsuccessful outreach attempts to members. IHA dummy codes submitted from claims are not accepted (effective Jan. 1, 2025).
- If your file was previously rejected, please review the reason for rejection, correct it and resubmit. If you have any questions about why the file was rejected, please contact your Provider Relations Representative.
Questions?
If you have questions about the Data Submission Tool, please email [email protected].
Medical record request for HEDIS Measurement Year (MY) 2025
The Alliance collects and reports Healthcare Effectiveness Data and Information Set (HEDIS) data annually, as required by California’s Department of Health Care Services (DHCS). As an Alliance provider, you have agreed to participate in our quality and audit programs, including providing medical records as needed. Please review the following details about an upcoming record request for MY2025.
Timeline and format
Be on the lookout for a patient medical record request from our vendor, KDJ Associates, Inc., between February and May 2026. They may contact you via:
- Fax.
- Mail.
- On-site visits.
- Remote electronic medical record (EMR) system access.
Please submit requested documentation within five days.
HEDIS measures under review
This year, we will be reviewing the following HEDIS measures:
- Cervical Cancer Screening.
- Controlling High Blood Pressure.
- Developmental Screening in the First Three Years of Life.
- Glycemic Status Assessment for Patients with Diabetes.
- Lead Screening in Children.
- Prenatal and Postpartum Care.
- Weight Assessment and Counseling for Nutrition and Physical Activity.
Using the data
We use this data to:
- Develop and enhance educational programs and member/provider benefits.
- Monitor:
- Quality of care delivered.
- Rate of access to preventive services.
- Management of chronic conditions.
- Provider performance.
- Health plan performance.
Questions?
- Find answers to frequently asked questions in the HEDIS FAQ Guide.
- You can also contact CJ Vansant, Alliance Quality Improvement Project Specialist, at either 831-430-5553 or [email protected].
Thank you for your cooperation and participation in this important project!
2025-2026 influenza season updates and reminders
Please note the changes made to Fluad®, Flublok® and Fluzone® high-dose influenza vaccines age ranges (bolded in the table).
Billing/coding updates
This guidance applies to all Alliance lines of business, effective Sept. 1, 2025, through June 30, 2026. It applies to members linked to your practice, non-linked members (no referral required) or administrative members.
| Vaccine Name | Dosage | Age Group | CPT Code |
| Afluria® (IIV3)
|
0.5 mL PFS 10-bx* | 3 years & older | 90656 |
| 5 mL MDV
.5 mL/dose |
3 years & older | 90658 | |
| Fluad® (IIV) | 0.5 mL PFS 10-bx* | 18 years & older | 90653 |
| Fluarix® (IIV3) | 0.5 mL PFS 10-bx* | 3 years & older | 90656 |
| Flublok® | 0.5 mL PFS 10-bx* | 9 years & older | 90673 |
| Flucelvax® (ccIIV3)
|
0.5 mL PFS 10-bx* | 6 months & older | 90661 |
| 5 mL MDV
.25 mL/dose |
6 months & older | 90661 | |
| FluLaval® (IIV3) | 0.5 mL PFS 10-bx* | 6 months & older | 90656 |
| FluMist®(LAIV3) | 0.2 mL spray 10-bx* | 2 to 49 years | 90660 |
| Fluzone® (IIV)
|
0.5 mL PFS 10-bx* | 6 months & older | 90656 |
| 5 mL MDV
.5 mL/dose |
3 years & older | 90658 | |
| Fluzone® High-Dose (IIV) | 0.5 mL PFS 10-bx* | 18 years & older | 90662 |
Immunization Registries
| Vaccine Name | Immunization Service Name with CVX* |
| Afluria®
|
Influenza, injectable, trivalent, pres free (140) |
| Influenza, injectable, trivalent (141) | |
| Fluad® | Influenza, injectable, subunit, adjuvanted, pres free (168) |
| Fluarix® | Influenza, injectable, trivalent, pres free (140) |
| Flublok® | Influenza, recombinant, trivalent, injectable, pres free (155) |
| Flucelvax®
|
Influenza, injectable, MDCK, pres free, trivalent (153) |
| Influenza, injectable, MDCK, trivalent (320) | |
| FluLaval® | Influenza, injectable, trivalent, pres free (140) |
| FluMist® | Influenza, live, intranasal, trivalent (111) |
| Fluzone®
|
Influenza, injectable, split virus, trivalent, pres free (140) |
| Influenza, injectable, split virus, trivalent (141) | |
| Fluzone® High-Dose | Influenza, injectable, high dose split virus, pres free (135) |
*Correct CVX code for immunization registries is needed for Care Based Incentives (CBI).
If patients/parents opt out of immunization registry sharing, vaccine information will not be available. A patient/parent may request to change their sharing status at any time. It can be updated through the registry’s website. For more information, please see disclosures on registry websites:
