Skip to content Find a Doctor Provider Portal Contact Us EnglishHmongSpanish aA Accessibility ToolsGrayscaleAAA English Hmong Spanish Search For Members Get Started Member ID Card Find a Doctor Alliance Alternative Access Standards About Your Health Plan Frequently Asked Questions Get Care Primary Care Approvals for Care Nurse Advice Line Prescriptions Introducing Medi-Cal Rx Urgent Care Urgent Visit Access – Merced County Urgent Visit Access – Monterey County Urgent Visit Access – Santa Cruz County Behavioral Health Transportation Services Other Services Dental and Vision Family Planning Medical Equipment Out-of-Area Services Enhanced Care Management and Community Supports Member Services Access Your Health Information COVID-19 Information Language Assistance File a Grievance California Children’s Services Join an Advisory Group Member Services Advisory Group (MSAG) Member Services Advisory Group Application Whole Child Model Family Advisory Committee (WCMFAC) Member Newsletter Online Self-Service Replace ID Card Change Primary Doctor Insurance Information Update Personal Information Information Release Privacy Request Request Personal Representative Member Reimbursement Claim Form Member Online Account Confidential Communications Request Form Find a Form Health and Wellness Managing Disease Staying Healthy Wellness Resources Health and Wellness Rewards For Providers Join Our Network Why Join How to Join Application Request Credentialing Applications and Policies New Provider Orientation Manage Care Behavioral Health California Children’s Services Clinical Resources Care Management Complex Case Management and Care Coordination Pain Management and Substance Use Resources Seniors and Disabilities Enhanced Care Management (ECM) and Community Supports Nurse Advice Line Referrals and Authorizations Telehealth Services Cultural and Linguistic Services Over-the-phone Interpreting Language List Face-to-Face Interpreter Request Form Interpreter Services Provider Quick Reference Guide Tips For Working With Interpreters Language Assistance Label Template Interpreter Services Quality Assurance Form A to Z Glossary of Spanish & Hmong Terms Promoting Cultural and Linguistic Competency Health Education and Disease Management Health Education Programs Breastfeeding Support and Breast Pump Benefit Disease Management Programs Health Resources Pharmacy Medi-Cal Rx Pharmacy Directory Pharmacy Formulary Prescription Drug Prior Authorization Prior Authorization Criteria Prior Authorization Information Request for Injectable Drugs Synagis Statement of Medical Necessity Treatment Authorization Request (TAR) Medical Nutrition Therapy Benefit Quick Reference Guide Quality of Care Care-Based Incentive Care-Based Incentive Resources Care-Based Incentive (CBI) Summary CBI Technical Specifications Antidepressant Medication Management Tip Sheet Immunizations: Adult – Exploratory Measure Tip Sheet Immunizations: Adolescents Tip Sheet Programmatic Measure Benchmarks & Performance Improvement Asthma Medication Ratio Tip Sheet 90-Day Referral Completion – Exploratory Tip Sheet Antidepressant Medication Management Tip Sheet Application of Fluoride Varnish Tip Sheet Immunizations: Children (Combo 10) Tip Sheet Chlamydia Screening in Women – Exploratory Measure Tip Sheet Child and Adolescent Well-Care Visits Tip Sheet Cervical Cancer Screening Tip Sheet Child and Adolescents BMI Assessment Tip Sheet Breast Cancer Screening Tip Sheet Well-Child Visits in the First 15 Months of Life Tip Sheet Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet Tuberculosis (TB) Risk Assessment – Exploratory Tip Sheet Preventable Emergency Visits Tip Sheet Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet Maternity Care: Prenatal Tip Sheet Maternity Care: Postpartum Tip Sheet Plan All-Cause Readmissions Tip Sheet Lead Screening in Children – Exploratory Measure Tip Sheet Initial Health Assessment Tip Sheet Diabetic HbA1c Poor Control >9% Tip Sheet Developmental Screening in the First 3 Years Tip Sheet Controlling High Blood Pressure – Exploratory Measure Tip Sheet Immunizations: Children (Combo 10) Tip Sheet Best Practices for Reducing Patient No-Shows Tip Sheet Ambulatory Care Sensitive Admissions Tip Sheet Depression Tool Kit USPSTF Recommendations for Primary Care Practice Preventable Emergency Care Visit Diagnosis Tip Sheet Blood Lead Testing Flyer California Management Guidelines: Childhood Lead Poisoning Standard of Care Guidelines: Childhood Lead Poisoning Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents – Exploratory Measure Tip Sheet Screening for Depression and Follow-Up Plan Tip Sheet What’s New Health Assessments Initial Health Assessment Billing Code List Staying Healthy Assessment (SHA) Fax Order Form HEDIS HEDIS Resources Behavioral Health Measures Child and Adolescent Health Measures Chronic and Persistent Conditions Health Measures Women’s Health Measures HEDIS Code Set HEDIS FAQ Guide Immunization Resources Member Incentives Site Reviews Facility Site Review Infection Control: Spore Testing Job Aid DHCS Facility Site Review (FSR) Checklist FSR Critical Elements: Interim Monitoring Form Medical Record Review DHCS Medical Record Review (MRR) Checklist Physical Accessibility Review Value-Based Payments Resources COVID-19 Claims View/Submit a Claim Forms Provider Directory Update Form News Provider Directory Provider Manual Timely Access to Care Webinars and Training Provider Events Calendar Provider Portal Using the Provider Portal Frequently Asked Questions Provider Portal User Guide Provider Portal Quick Reference Provider Portal Account Request Form Procedure Code Lookup Tool Updates to provider communicationsWe have made some updates to our publications.For Communities Healthy Communities Your Health Matters Community-Based Adult Services Community Resources Community Grants Medi-Cal Capacity Grants Funding Opportunities Capital Program Provider Recruitment Program Partners for Healthy Food Access Program How to Apply Using the Grant Portal Community Publications Impact Reports The Beat E-Newsletter Medi-Cal for ages 50+More people are now eligible for health care.Health Plan Medi-Cal Alliance Care IHSS We are hiring!Join our mission-driven team.About Us About the Alliance Fact Sheet Mission, Vision and Values Strategic Plan 2022-2026 Leadership Public Meetings Careers Contact Us News Community News Member News Provider News Meetings and Events Newsroom We speak your languageLearn more about language assistance services. For Members Get Started Member ID Card Find a Doctor Alliance Alternative Access Standards About Your Health Plan Frequently Asked Questions Get Care Primary Care Approvals for Care Nurse Advice Line Prescriptions Introducing Medi-Cal Rx Urgent Care Urgent Visit Access – Merced County Urgent Visit Access – Monterey County Urgent Visit Access – Santa Cruz County Behavioral Health Transportation Services Other Services Dental and Vision Family Planning Medical Equipment Out-of-Area Services Enhanced Care Management and Community Supports Member Services Access Your Health Information COVID-19 Information Language Assistance File a Grievance California Children’s Services Join an Advisory Group Member Services Advisory Group (MSAG) Member Services Advisory Group Application Whole Child Model Family Advisory Committee (WCMFAC) Member Newsletter Online Self-Service Replace ID Card Change Primary Doctor Insurance Information Update Personal Information Information Release Privacy Request Request Personal Representative Member Reimbursement Claim Form Member Online Account Confidential Communications Request Form Find a Form Health and Wellness Managing Disease Staying Healthy Wellness Resources Health and Wellness Rewards For Providers Join Our Network Why Join How to Join Application Request Credentialing Applications and Policies New Provider Orientation Manage Care Behavioral Health California Children’s Services Clinical Resources Care Management Complex Case Management and Care Coordination Pain Management and Substance Use Resources Seniors and Disabilities Enhanced Care Management (ECM) and Community Supports Nurse Advice Line Referrals and Authorizations Telehealth Services Cultural and Linguistic Services Over-the-phone Interpreting Language List Face-to-Face Interpreter Request Form Interpreter Services Provider Quick Reference Guide Tips For Working With Interpreters Language Assistance Label Template Interpreter Services Quality Assurance Form A to Z Glossary of Spanish & Hmong Terms Promoting Cultural and Linguistic Competency Health Education and Disease Management Health Education Programs Breastfeeding Support and Breast Pump Benefit Disease Management Programs Health Resources Pharmacy Medi-Cal Rx Pharmacy Directory Pharmacy Formulary Prescription Drug Prior Authorization Prior Authorization Criteria Prior Authorization Information Request for Injectable Drugs Synagis Statement of Medical Necessity Treatment Authorization Request (TAR) Medical Nutrition Therapy Benefit Quick Reference Guide Quality of Care Care-Based Incentive Care-Based Incentive Resources Care-Based Incentive (CBI) Summary CBI Technical Specifications Antidepressant Medication Management Tip Sheet Immunizations: Adult – Exploratory Measure Tip Sheet Immunizations: Adolescents Tip Sheet Programmatic Measure Benchmarks & Performance Improvement Asthma Medication Ratio Tip Sheet 90-Day Referral Completion – Exploratory Tip Sheet Antidepressant Medication Management Tip Sheet Application of Fluoride Varnish Tip Sheet Immunizations: Children (Combo 10) Tip Sheet Chlamydia Screening in Women – Exploratory Measure Tip Sheet Child and Adolescent Well-Care Visits Tip Sheet Cervical Cancer Screening Tip Sheet Child and Adolescents BMI Assessment Tip Sheet Breast Cancer Screening Tip Sheet Well-Child Visits in the First 15 Months of Life Tip Sheet Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet Tuberculosis (TB) Risk Assessment – Exploratory Tip Sheet Preventable Emergency Visits Tip Sheet Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet Maternity Care: Prenatal Tip Sheet Maternity Care: Postpartum Tip Sheet Plan All-Cause Readmissions Tip Sheet Lead Screening in Children – Exploratory Measure Tip Sheet Initial Health Assessment Tip Sheet Diabetic HbA1c Poor Control >9% Tip Sheet Developmental Screening in the First 3 Years Tip Sheet Controlling High Blood Pressure – Exploratory Measure Tip Sheet Immunizations: Children (Combo 10) Tip Sheet Best Practices for Reducing Patient No-Shows Tip Sheet Ambulatory Care Sensitive Admissions Tip Sheet Depression Tool Kit USPSTF Recommendations for Primary Care Practice Preventable Emergency Care Visit Diagnosis Tip Sheet Blood Lead Testing Flyer California Management Guidelines: Childhood Lead Poisoning Standard of Care Guidelines: Childhood Lead Poisoning Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents – Exploratory Measure Tip Sheet Screening for Depression and Follow-Up Plan Tip Sheet What’s New Health Assessments Initial Health Assessment Billing Code List Staying Healthy Assessment (SHA) Fax Order Form HEDIS HEDIS Resources Behavioral Health Measures Child and Adolescent Health Measures Chronic and Persistent Conditions Health Measures Women’s Health Measures HEDIS Code Set HEDIS FAQ Guide Immunization Resources Member Incentives Site Reviews Facility Site Review Infection Control: Spore Testing Job Aid DHCS Facility Site Review (FSR) Checklist FSR Critical Elements: Interim Monitoring Form Medical Record Review DHCS Medical Record Review (MRR) Checklist Physical Accessibility Review Value-Based Payments Resources COVID-19 Claims View/Submit a Claim Forms Provider Directory Update Form News Provider Directory Provider Manual Timely Access to Care Webinars and Training Provider Events Calendar Provider Portal Using the Provider Portal Frequently Asked Questions Provider Portal User Guide Provider Portal Quick Reference Provider Portal Account Request Form Procedure Code Lookup Tool Updates to provider communicationsWe have made some updates to our publications.For Communities Healthy Communities Your Health Matters Community-Based Adult Services Community Resources Community Grants Medi-Cal Capacity Grants Funding Opportunities Capital Program Provider Recruitment Program Partners for Healthy Food Access Program How to Apply Using the Grant Portal Community Publications Impact Reports The Beat E-Newsletter Medi-Cal for ages 50+More people are now eligible for health care.Health Plan Medi-Cal Alliance Care IHSS We are hiring!Join our mission-driven team.About Us About the Alliance Fact Sheet Mission, Vision and Values Strategic Plan 2022-2026 Leadership Public Meetings Careers Contact Us News Community News Member News Provider News Meetings and Events Newsroom We speak your languageLearn more about language assistance services. Home > Developer Questionnaire Developer Resources Patient Access Provider Directory API Developer Application Developer Questionnaire Step 1 of 4 25% HiddenPrevious Entry Consent Management, Use and DisclosureYour application is compliant with the FTC Principle of Collection Limitation of personal data(Required) Yes No Your Application is compliant with the FTC User Limitation which describes data should be used only for the purposes specified at the time of collection(Required) Yes No Your application provides members the ability to request the secure and complete disposal of their identifiable health data(Required) Yes No Your application provides each individual a right to see any data bout him or herself. Your application also allows them to annotate any data that is not timely, accurate, relevant, or complete(Required) Yes No Security and Incident ManagementOn behalf of Central California Alliance for Health's members, your application request a copy of their health data (ePHI) from the HIPAA designated record set, maintained by a health care provider, health plan or health information exchange as per below mentioned methods:By relying on a health care provider or health plan portal's 'Identity Credential' using SMART or, by accepting a 'Digital Identity Credential' for the member that is at least NIST Identity Assurance level2 (IAL2) and Authenticator Assurance level2 (AAL2)(Required) Yes No By clearly indicating the destination for sending the personal data including ePHI(Required) Yes No Your application protects personal data through mechanisms including, at minimum:(Required) Secure storage Encryption of digital records, both in transit and at rest Data use Agreements and Contractual obligations Accountability measures Yes No Your application practices a defined policy to handle dormant accounts(Required) Yes No Your application adopts internal policies and secure contractual commitments with third parties to prohibit the re-identification of de-identified or anonymized data(Required) Yes No Your application provides a mechanism to verify that ePHI/personal data has not been altered, modified, or destroyed in an unauthorized annotation, or disclosure manner(Required) Yes No You agree to comply with applicable breach notification laws and provide meaningful remedies to address security breaches, privacy or other violations incurred because of misuse of the member's health information(Required) Yes No Your application has proper authentication and authorization controls, as per best practices(Required) Yes No Application and Data SecurityYour application mitigates the OWASP top 10 Application Security Risks(Required) Yes No Your application has a mechanism to verify that ePHI has not been altered, modified, or destroyed in an unauthorized manner(Required) Yes No Your application's error handling process ensures that no sensitive or personal information is disclosed(Required) Yes No Your application does not use production data in the test environment for testing purposes(Required) Yes No Your application ensures data backup and data recovery best practices(Required) Yes No Your application generates system and application level audit logs as per HIPAA requirements(Required) Yes No Your application audit logs are secured and reviewed periodically(Required) Yes No Your application mitigates the OWASP Mobile Top 10 Security Risks(Required) Yes No Your application follows industry best practices for data encryption(Required) Yes No Does your application require a usage fee either from members or plans(Required) Yes No Is your application hosted and developed outside of the United States(Required) Yes No Information Attestation(Required) I hereby confirm and owe that the information provided herein, is accurate, correct and complete. I am attesting on behalf of my organization in capacity of third-party or vendor who I represent and I am associated with. I stand accountable for the information and the documents submitted with regards to their authenticity and validity. The Alliance shall not be responsible or accountable for any of the information provided herein. I understand and agree that a false statement may disqualify me for the opportunity and the benefits presented herein. CAPTCHAEmailThis field is for validation purposes and should be left unchanged. Contact us | Toll free: 800-700-3874
