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Provider Digest | Issue 4

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Updated customer service hours

The Provider Services Department has updated our customer service phone line hours.

You can reach a live Provider Relations Representative (PRR) during the following hours:

Monday-Friday from 9 a.m.-12 p.m. and 1-5 p.m.

(Closed for lunch from noon until 1 p.m.)

Call 831-430-5504 o 800-700-3874, ext. 5504.

We look forward to supporting our valued providers as we work together to purse a vision of Healthy People, Healthy Communities.

We are also pleased to support our providers with access to the latest news and information about Alliance programs, incentives and more on our provider website.

Value-based payments program ends

The Department of Health Care Services (DHCS) Value-Based Payment (VBP) program, funded through Proposition 56, has ended effective June 30, 2022.

The VBP program was designed to provide incentive payments to qualifying providers for meeting specific measures in prenatal/postpartum care, early childhood preventive care, chronic disease management and behavioral care to improve care for certain high-cost or high-need populations.

Services performed after June 30, 2022 will not be eligible to receive VBPs. Claims for VBP services received up to one year after the date of service will continue to be paid if the date of service for the claim was on or before June 30, 2022. DHCS will release an updated All Plan Letter in the near future.

The Alliance remains committed to supporting providers in delivering quality, accessible health care guided by local innovation. We continue to offer our care-based incentive program for contracted providers, including programmatic and fee-for-service measures.

Annual Provider Appointment Availability Survey

Every year, the Alliance administers the Provider Appointment Availability Survey (PAAS) to assess our network’s ability to provide care within timely access standards. We recognize the many challenges faced by providers throughout the pandemic, and that access to care has been heavily impacted by factors related to COVID-19. We are committed to conducting outreach that is as minimally impactful as possible to the daily operations of your office.

In addition, we recognize the different modalities of care utilized by providers this year, including telephonic appointments. Please note that telehealth appointments do demonstrate the means to provide timely access to care and should be included in your responses, if available.

To help set your office up for success, we have also included a brief list of timely access best practices in the information below.

Thank you for your participation and for your collaboration in providing accessible, quality health care to Alliance members!

Survey timing

The Alliance will be launching the PAAS in late August.

Survey format

  • You will initially receive the survey by email.
  • If no response is received within 5 business days, you will receive the survey by phone.

Please encourage your reception staff to participate in survey calls. You may receive requests from multiple health plans to complete the PAAS.

Timely access guidelines

Specific guidelines for timely access to care are outlined in:

Both policies can be found in the Alliance Provider Manual.

Timely access standards monitored through the PAAS include the following:

Urgent Care Appointments Wait Times
Services that do not require prior authorization 48 hours
Specialty services that require prior authorization 96 hours
Non-Urgent Care Appointments Wait Times
Primary care (including first prenatal and preventive visits) 10 business days
Mental health care appointment (with a non-physician provider) 10 business days
Follow up appointment with a mental health care (non-physician) provider or substance use disorder provider 10 business days from the prior appointment
Specialist appointments (including psychiatry) 15 business days
Physical therapy or mammography appointment for the diagnosis or treatment of injury, illness or other health condition 15 business days

Thank you for your participation in this year’s PAAS. If you have questions, please contact an Alliance Provider Relations representative at 800-700-3874, ext. 5504.

Timely access best practices

Scheduling guidelines

  • Maintain a waitlist for same-day or next-day appointments and fill appointments as cancellations occur. Some clinics integrate the wait list into the Electronic Medical Records (EMR).
  • Implement same-day confirmation calls a few hours before the appointment to avoid no-shows and schedule waitlist patients as appointments open up.
  • Block up to four appointments in the morning and afternoon on each provider’s schedule to accommodate same-day requests.
  • Assign RN or LVN staff to phone triage patients to ensure appropriate scheduling of same-day appointments.
  • Consider rotating provider shifts to see walk-in, overflow or waitlist patients.
  • Make use of informative hold messages that include:

Flexibility is key

  • Offer extended office hours on certain days to accommodate same-day and waitlist patients.
  • If a patient arrives early, consider seeing them upon arrival, potentially freeing up an appointment slot for a waitlist patient.
  • Consider double-booking patients with a history of no-shows.
  • If a clinic has multiple sites and the patient is able to commute, refer to providers with last-minute appointments at other sites.

Educate and organize

  • Provide receptionists with timely access standards in training materials and follow up with reminders on a regular basis.
  • Motivate staff to ensure patients are scheduled as soon as possible, whenever possible.
  • Assign each reception employee specific roles (checking in, checking out, phone calls, etc.).