Clinical Resources

The Alliance offers a comprehensive set of services to help patients and their providers manage chronic or complex conditions. Visit the Care Management page for more information.

Complex Case Management and Care Coordination

Visit the Complex Case Management and Care Coordination page for information on:

• How we support members.
• Which situations qualify for complex case management.
• How our Care Coordination team assists members with less complex, non-clinical needs.

Pain Management Resources

Consult the Pain Management and Substance Use Resources page for information and trainings on safe, compassionate and effective methods to help members manage pain, including:

• Clinical guidelines and best practices for pain management and opioid safety.
• Medical Assisted Treatment (MAT).
• Provider training and Continuing Medical Education (CME)/Continuing Education (CE) on pain and substance use management.
• Patient education and helpful websites.
• Pharmacy tools and resources.

Seniors and Disabilities

View the Seniors and Disabilities page for information on:

• ADA compliance.
• Provider training and resources for serving seniors and people with disabilities (SPDs).
• Alliance programs and services for members who are SPDs.

A key feature of CalAIM is the introduction of Enhanced Care Management (ECM) in the Medi-Cal managed care delivery system, and a new menu of Community Supports, or in lieu of services (ILOS), which can serve as cost-effective alternatives to covered Medi-Cal services.

Learn more on our Enhanced Care Management and Community Supports page. 

Members can call the Nurse Advice Line to have their health questions answered 24/7, such as in the following situations:

• Member has a non-emergency question when your office is closed.
• Member is unable to reach you.

View the Referrals and Authorizations page for information on the following types of referrals and authorizations:

Referrals from Emergency Department (ED)

• A list of specialists and treatments that ED providers may directly refer to without prior authorization.

Referrals for Complex Case Management and Care Coordination

• Form for referring members with complex cases: certain chronic illnesses, catastrophic diagnoses and other complex medical issues.
• Form for referring members to care coordination: less complex, non-clinical needs such as durable medical equipment and transportation.

Prior Authorizations

• How to request and submit prior authorizations, as service providers are responsible for obtaining Alliance approval before certain services are administered.

Utilization Management (UM)

• The components of the Alliance’s UM program and details of the decision hierarchy involved in making medical necessity determinations.

The Alliance offers telehealth services to better serve members in rural and other medically underserved areas. The Telehealth Services page details how to use our two options for providers:

• eConsult: allows PCPs to consult online with specialists.
• TeleSpecialty Care: enables PCPs to coordinate video consultations between specialists and patients from the provider’s office.