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Provider Digest | Issue 13

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Encouraging patients to get the bivalent booster

Recommended for people 5 years and older, the bivalent COVID-19 booster helps protect against both the original COVID-19 virus and the Omicron variants.

Data from early November shows the following rates of vaccination with the bivalent booster:

  • Merced County: 6.0%
  • Monterey County: 11.8%
  • Santa Cruz County: 18.9%

Bivalent booster uptake is lagging, especially among:

  • Males.
  • Those under 20 years old.
  • Latino and American Indian/Alaska Native communities.

Now is the time to encourage patients to get that added layer of protection through the holidays and winter season. Alliance members can find COVID-19 resources in English, Spanish and Hmong on our website. Members can quickly and easily find a nearby location to get vaccinated at www.vaccines.gov.

Vaccine data and recommendations

For the latest COVID-19 vaccine recommendations, visit the CDC vaccine page. Access more data on vaccination rates by county, age, and race and ethnicity on the California State Government website.

Provider best practices for grievance investigations

The Alliance aligns with all Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS) requirements to ensure compliance with grievance processes. As such, we request that Alliance providers respond in a timely fashion to all grievance investigations, including allegations of discrimination. A timely response is typically within five to ten business days from the date our Provider Relations team requests a review.

As a best practice, we recommend implementing policies and procedures for non-discrimination and timely response to grievance investigation requests.

Helpful tips

  • Identify one or two staff members to review and respond to requests. This could be an office manager, supervisor or quality/risk specialist.
  • Educate the assigned staff on the importance of a complete review along with a timely and concise response to the Plan.
  • Encourage staff to contact their assigned Provider Relations Representative with any questions.

Specific to allegations of discrimination

The Alliance is required to provide the State with the provider’s point of contact (the person who investigated and responded to the Alliance grievance request). Please include the point of contact’s name and contact information. This information is required by the Office of Civil Rights (OCR).

It may be helpful to include additional information, like:

  • The provider’s non-discrimination policy.
  • Dates of last training, coaching or actions taken following your review of the records/concerns.

References

  • Medi-Cal grievance requirements: APL 21-011.
  • Nondiscrimination requirements: APL 21-004.
  • Additional information about provider responsibilities in the grievance process: Provider Manual, Section 17.

The Provider Portal gets a makeover

Coming Dec. 4, you may notice the Provider Portal looks a little different.

We made some visual updates to our Provider Portal homepage to make it easier to find the tools and news you need. The functions you already use will be in the same spot – just with a new look and feel!

There are a few new features we’ve added to the portal home page to ensure providers have the latest news and information from the Alliance, including:

  • Portal News: updates about Provider Portal reporting and tools.
  • Provider News: a feed of the latest need-to-know provider news from our provider publications.
  • Provider Events Calendar: a feed of upcoming webinars and trainings for Alliance providers.

We hope you find these upgrades helpful! If you need any assistance, please contact Alliance Provider Services at 831-430-5504.

To give you a sneak peek of these exciting changes, we’ve included screenshots below of the current portal home page and what it will look like after the Dec. 4 release.

Provider Portal before

Screenshot of the old Provider Portal.

Provider Portal after

Screenshot of the new Provider Portal