Manage Care

Review the Behavioral Health page that shows services available to Alliance members with mild to moderate mental health conditions, as well as resources for acute mental health needs.

Visit the California Children’s Services page to learn about this statewide program for members under 21 years of age with certain serious medical conditions. View information on benefits, services, eligibility requirements and how to become CCS-paneled.

The Alliance offers services and clinical care resources to help providers deliver quality care to our members.

• Nurse Advice Line
  Members can call the Nurse Advice Line to have their health questions answered 24/7.
• Telehealth
  The Alliance offers telehealth services to better serve members in rural and other medically underserved areas. Our Telehealth page details how to use eConsult and TeleSpecialty Care options.
• Referrals and Authorizations
  View the Referrals and Authorizations page for information on the following types of referrals and authorizations:
  • Referrals from Emergency Department
  • Referrals for Complex Case Management and Care Coordination
  • Prior Authorizations
  • Utilization Management
• Care Management
  The Alliance offers a comprehensive set of services to help patients and their providers manage chronic or complex conditions more effectively.
• Complex Cases and Care Coordination
  Visit the Complex Cases and Care Coordination page for information on how the Alliance partners with providers to care for members with complex medical needs, as well as how our Care Coordination team assists members with less complex, non-clinical needs.
• Pain Management Resources
  Consult the Pain Management Resources page for information and trainings on safe, compassionate and effective methods to help members manage pain.
• Seniors and Disabilities
  View the Seniors and Disabilities page for information on ADA compliance.

The Alliance ensures that all members have access to and can understand health care providers and services. The Cultural and Linguistic Services page provides:

• Information on language assistance, including telephonic and face-to-face interpreter services.
• Resources for caring for diverse populations.

Refer to the Health Education and Disease Management page for information on the Alliance’s health programs, disease management programs, incentives and wellness resources for members.

Visit the Pharmacy page for details on formularies, authorizations, billing and reimbursement, specialty and mail order pharmacies, pharmacy benefits and more.

The topics below include information on best practices, care-based incentives and resources, and tools and assessments to aid in providing quality care to members.

• Immunization Resources
  Visit the Immunization Resources page for resources, provider requirements, vaccine schedules and printable immunization materials for members of all ages.
• Health Assessments
  Refer to the Health Assessments page for details on the following DHCS-required assessments:
  • Initial Health Assessment
  • Staying Healthy Assessment
  • Unhealthy Alcohol Screening and Behavioral Counseling
• Care-Based Incentive
  The Care-Based Incentive (CBI) program offers financial incentives and technical assistance to primary care providers (PCPs) to support them in helping members manage their own care and reduce health care costs. Visit our Care-Based Incentive page for information about the CBI program. Learn about the many ways the Alliance encourages members to stay healthy on our Member Incentives page.
• Value-Based Payments
  Visit our Value-Based Payments page for information on provider incentive payments for meeting specific measures of care.
• Site Reviews
  The Site Reviews page provides information for primary care provider sites to ensure they are meeting prescribed standards of care for the following review processes:
  • Facility Site Review
  • Medical Records Review
  • Physical Accessibility Review
• HEDIS
  Our HEDIS page explains the role of this performance measurement tool, how the Alliance collects HEDIS data and how providers can complete requests to submit member data.