Behavioral Health
Behavioral health care is now at the Alliance
Central California Alliance for Health directly manages Mental Health Services for our members. Providers work directly with the Alliance to deliver behavioral health care. The goal is to improve care coordination by integrating behavioral and physical health, ensuring members receive more connected and comprehensive support for their overall well-being. Learn how to become an Alliance Behavioral Health Provider.
PCPs can contact the Alliance for behavioral health screenings or assessments and Alliance member referrals. Please note that while most behavioral health services do not require a referral, there are several ways for members to get connected.
- Call the Alliance member service line Monday through Friday, from 8 a.m. to 5:30 p.m. at 800-700-3874.
- TotalCare members should call the TotalCare Member Services line: 833-530-9015 (TTY: 800-735-2929 (Dial 711)), 8 a.m. to 8:00 p.m., seven days a week.
- Providers can call the Alliance Care Management line at 800-700-3874 x5512.
- Providers can submit a Care Management Referral Form directly through the Alliance website, via fax to 831-430-5850 or via e-mail to list CM behavioral health team at [email protected].
Alliance Primary Care Providers (PCPs) are responsible for identifying the need for behavioral health screenings and referrals.
Behavioral health services covered by the Alliance include:
- Mental health evaluation and treatment, including individual, group and family psychotherapy.
- Psychological and neuropsychological testing, when clinically indicated to evaluate a mental health condition.
- Outpatient services for the purposes of monitoring drug therapy.
- Outpatient laboratory, drugs, supplies and supplements (excluding anti-psychotic drugs, which are covered by Medi-Cal Fee-For-Service).
- Psychiatric consultation.
The Alliance covers inpatient and hospital care and intensive outpatient services for In-Home Supportive Services (IHSS) and TotalCare (DSNP) members.
Looking to support your patients with depression? Check out our:
This guide is designed to help primary care physicians and office staff identify and treat depression in patients.
Primary care provider support
Medical and Behavioral Health providers can outreach to the Behavioral Health Department directly at [email protected] if they have questions about behavioral health services or wish to consult with the Behavioral Health Medical Director directly for any questions related to psychiatric diagnosis or medication. Please allow the BH team two business days to respond.
Additional Resources to support PCPs and providers regarding Behavioral health treatment include:
Cal-MAP | A CalHOPE program powered by UCSF - The California Child and Adolescent Mental Health Access Portal (Cal-MAP) is a CalHOPE pediatric mental health care access program designed to increase timely access to mental health care for youth throughout California's communities, especially in the state’s most underserved and rural areas. Cal-MAP’s team of psychiatrists, psychologists and social workers provide no-cost consultation, education, and resource navigation to California Primary Care Providers (PCPs) caring for mental and behavioral health concerns in patients ages 0-25.
Continuing Medical Education > Train New Trainers (TNT) Fellowships | UCI School of Medicine - TNT has been at the forefront of integrating mental health care into primary practice. Their program has equipped countless primary care providers with essential behavioral health skills, making a real difference in patient care.
Contact Escalation
If providers are having a difficult time connecting members to care, please contact Alliance Provider Services for support at [email protected] or 831-430-5504.
Acute medical detoxification, meaning treatment in an acute medical facility for a serious medical condition relating to substance withdrawal, is also available from the Alliance with prior authorization. For acute medical detoxification services, call the Alliance at 800-700-3874, Monday-Friday, 8 a.m. to 5:30 p.m. TotalCare members should call 833-530-9015 (TTY: 800-735-2929 (Dial 711)), 8 a.m. to 8:00 p.m.
Emergency and Crisis Contacts
If a member is having a psychiatric emergency and needs immediate help, call 911.
If a member needs to talk about urgent mental health concerns related to thoughts of self-harm or suicide, please refer the member to call the Suicide and Crisis Lifeline: 988. It is available 24 hours a day in English and Spanish.
Members may also contact our Nurse Advice Line 24 hours a day, 7 days a week at no cost to them, if they have any medical questions, want care advice or need help deciding if they need to see a provider. When calling, it is recommended to have their Alliance Member ID card with them to tell the nurse their ID number. Call 844-971-8907 (TTY: Dial 711).
|
Measure |
Requirement |
Incentive Amount |
Payment Frequency |
Goal |
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|
Coordination with Primary Care Provider |
Submit claims using code G9968 and modifier U3 to signify communications with a PCP within 30 days of a member’s behavioral health visit. |
$25 per member |
Quarterly |
Increase data sharing and collaboration between BH providers and PCPs. |
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|
Provider completion of Satisfaction Survey |
Complete the Provider Satisfaction Survey (survey responses are anonymous). |
$100 per survey response |
Annual |
Improve Provider Satisfaction Survey responsiveness. |
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|
Provider completion of DEIB training |
Complete the Alliance DEIB training either in person or online. This measure will only be effective if DHCS makes it a requirement for Medi-Cal providers to complete a health equity training within the 2025 calendar year. |
$200 per provider |
Annual |
Provider training to meet health equity accreditation and DHCS requirements. |
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|
Increase in volume of members seen |
Claims data will assess distinct members seen in measurement quarter against the prior year. |
|
Quarterly |
Expand provider acceptance of members and increase the number of members seen with timely access to care. |
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|
Provider completion of ACES training and attestation |
Completion of a valid Adverse Childhood Experiences (ACEs) training accompanied by an attestation to DHCS. |
$200 per provider |
Quarterly |
Increase ACES screenings. |
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|
Increase access – community settings |
Submit claims for community setting with the following place of service codes:
|
$25 per visit |
Quarterly |
Reduce access to barriers and increase members’ access to care outside clinic settings / community setting. |
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|
Emergency Department (ED) follow-up visit |
Submit claim for service rendered within 30 days of a member discharge from an ED visit related to a mental health or substance abuse disorder. |
$50 per visit |
Annual |
Reduce ED visits and inpatient admissions through FUA/FUM HEDIS. |
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|
Annual bilingual bonus |
Note bilingual capability on credentialing application and submit at least one claim in the measurement year. |
$250 per provider |
Annual |
Reduce equity and disparity gap. |
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|
Bilingual visit add-on |
Note bilingual capability on credentialing application and submit a claim for service rendered to member in member’s preferred language. |
$10 per visit |
Quarterly |
Improve member quality of care. |
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The Alliance also provides behavioral health resources for In-Home Supportive Services (IHSS) in Monterey County. For Alliance Care IHSS members, the Alliance covers both inpatient and outpatient mental health and substance abuse disorder services provided by a participating mental health professional or hospital. Some services require prior authorization.
While the Alliance is responsible for the provision of Non-Specialty Mental Health Services (NSMHS), previously known as mild to moderate services, the County Mental Health Plan (MHPs) are responsible for the provision of Specialty Mental Health Services (SMHS), previously known as moderate to severe services, for Medi-Cal members, as well as a continuum of substance use disorder services. Eligibility for SMHS is defined in Behavioral Health Information Notice 21-073. The behavioral health access department in each county is a helpful resource to explore which services would be most beneficial based on individual needs.
Providers should refer Medi-Cal members to their county behavioral health department if the member:
- Requires specialty mental health treatment.
- Requires substance use disorder treatment other than acute medical detoxification.
For county-specific behavioral health referral information, view the section for your service area.
Mariposa County
| Organization | Conditions/Services | Phone Number |
|---|---|---|
| Mariposa County Behavioral Health and Recovery Services | ||
| Specialty mental health services | 800-549-6741 24 hours/day or The Behavioral Health & Recovery Services Department at (209) 742-0802, Monday-Friday, 8 a.m.–5 p.m. |
|
| Substance use disorder services | 800-549-6741 24 hours/day |
Merced County
| Organization | Conditions/Services | Phone Number |
|---|---|---|
| Merced County Behavioral Health and Recovery Services | ||
| Specialty mental health services |
209-381-6800, 888-334-0163 24 hours/day |
|
| Substance use disorder services |
209-381-6850 24 hours/day |
Monterey County
| Organization | Conditions/Services | Phone Number |
|---|---|---|
| Monterey County Behavioral Health | ||
| Specialty mental health services |
888-258-6029 |
|
| Behavioral health access |
888-258-6029 |
San Benito County
| Organization | Conditions/Services | Phone Number |
|---|---|---|
| San Benito County Behavioral Health | ||
| Specialty mental health services |
888-636-4020 |
|
| Substance use disorder services |
888-636-4020 |
Santa Cruz County
| Organization | Conditions/Services | Phone Number |
|---|---|---|
| County of Santa Cruz Behavioral Health Services | Specialty mental health services | 800-952-2335 24 hours/day |
| Substance use disorder services | 831-454-4050 |
Maternal Mental Health (MMH) disorders include a range of disorders and symptoms including depression, anxiety, bipolar disorder, suicidality, OCD and psychosis. These disorders and symptoms can occur during pregnancy and/or during the perinatal period. Perinatal Mood and Anxiety Disorders (PMAD) are some of the most common medical complications during pregnancy and the postpartum period. OB-GYNs, primary care providers and other obstetric care providers play a critical role in identifying, diagnosing and initiating treatment for these pervasive complications.
Along with good history taking, ACOG cites the following validated screenings in their toolkit for Perinatal Mental Health:
Depression
- The Edinburgh Postnatal Depression Scale is a 5-minute questionnaire with 10 questions, designed specifically for pre- and post-natal screening. It is available in multiple languages from the Massachusetts Child Psychiatry Access Program. Please note that not all versions are validated — use at your discretion or
- The Patient Health Questionnaire-9 (PHQ9) is a general screening tool for depression with 9 questions.
Anxiety
- The General Anxiety Disorder 7 Screen (GAD-7) has 7 questions to assess anxiety symptoms over the past two weeks.
PTSD
- The Primary Care PTSD Screen for DSM-5 (PC-PTSD) is a brief 5 item screen to identify possible PTSD in the primary care setting.
Bipolar Disorder
- Mood Disorder Questionnaire (MDQ) is a self-report screening tool that looks at possible symptoms of mood disorders, particularly bipolar disorder.
In addition to the above, there are other validated screeners and assessments that can be used, such as:
Suicidal Risk
- The Columbia-Suicide Severity Rating Scale (C-SSRS) is a short questionnaire to help identify if someone is at risk for suicide, examine the severity and immediacy of the risk, and look at the level of support needed. Various screeners and further assessments are available.
Behavioral health treatment is a covered benefit for eligible Medi-Cal members.
Services are provided to members under the age of 21 when deemed medically necessary according to EPSDT guidelines. PCPs play an important role in identifying and referring children who need behavioral health treatment. It is critical that PCPs provide medical follow-up for co-occurring disorders.
Prior authorization from the Alliance is required for Applied Behavioral Analysis (ABA) services except for Functional Behavior Assessment (FBA) which can be conducted without prior authorization. BHT services are provided to members when a recommendation is made by a licensed physician, psychologist or surgeon and deemed to be medically necessary. It should be noted that in efforts to ensure accessibility to BHT services and minimize delays members may initiate an FBA with a servicing provider without prior authorization and regardless of diagnosis. BHT services include ABA and other evidence-based services aimed at shaping behavior.
If a member is receiving care from an Alliance provider, the providers will ask members to sign a statement authorizing the clinician to share clinical status information with a PCP and for the PCP to respond with additional member status information, to the extent permitted by law. Members may elect to authorize or refuse to authorize release of information except as required by federal, state and local laws.
The Alliance recommends the following resources:
CalHOPE Connect offers safe, secure and culturally sensitive emotional support for Californians in issues related to COVID-19.
Referrals
- For a Care Management Referral, please submit here: Care Management Referral Form - Central California Alliance for Health.
Screening and Evaluation
For information on how to become a behavioral health provider serving the communities in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties, please reach out to the Alliance at [email protected] or the Alliance's Join our network page.
Modifier Requirements for Covered Behavioral Health Services
Effective dates of service July 1, 2025, the Alliance will directly manage non-specialty behavioral health (BH) services for our Medi-Cal and IHSS members, as well as specialty mental health services for IHSS members. Claims for these services must include one the following modifiers: AF, AH, AS, AJ, HO, or HL. Claims submitted without one of these modifiers will be denied.
These modifiers are used to identify the Providers qualifications (professional level or credential). Proper use ensures accurate reimbursement and compliance.
| Modifier | Description | Appropriate for | Provider Type Examples | Use Guidance |
|---|---|---|---|---|
| AF | Specialty physician | Physicians providing BH services | Psychiatrists (MD/DO) | Use when services are rendered by a medical doctor specializing in psychiatry |
| AH | Clinical psychologist | Licensed Psychologists | PhD or PsyD psychologists | Use when services are rendered by a licensed clinical psychologist |
| AS | Physician assistant (PA), or Nurse practitioner (NP) | PA/NP working under physician supervision | PA under a psychiatrist | Use only when a PA/NP is billing under the supervising psychiatrist |
| AJ | Clinical social worker | Licensed Clinical Social Workers (LCSWs) | LCSW, LMSW (if permitted in your state) | Use for services rendered by LCSWs or equivalent licensed professionals |
| HO | Master’s level clinician | Non-physician BH providers with a master’s degree | LMFTs, LPCC | Use for services rendered by a master’s-level behavioral health clinician |
| HL | Intern, resident, or trainee | Providers in clinical training or under supervision | Registered Psychological Associate, Associate CSW, Associate Marriage and Family Therapist, Associate Professional Clinical Counselor | Use when services are provided by a supervised intern or trainee |
Please note, these modifier requirements only apply to behavioral health services. Providers who are not classified as BH specialists and are delivering non-BH services are not expected to use these modifiers.
