Request for Member Reassignment Form
Complete this form to request that an Alliance member be reassigned to a new primary care provider (PCP). This form is only for linked Alliance members.
If a member wants to change their PCP, they may either do so by calling Member Services toll-free at 800-700-3874 or in the My Health Member Portal. (Note: The portal is currently available in English only and is intended for users ages 18 and older. Members must create an account.)
Please review the full guidance for member reassignment below before submitting a request.
Appropriate reasons for member reassignment
A PCP may request that the Alliance reassign a member linked to their practice to another PCP based on the following criteria.
The PCP alleges that the member fraudulently sought or received covered services for him or herself or another party. The PCP alleges that the member has committed theft from the practice.
The PCP alleges that the member behaves in a threatening, abusive or disruptive manner to provider or office personnel. This may include abusive language, threat of bodily harm or threat of property damage.
A member violates the Medication Management Agreement he/she has agreed to with the PCP, and which the PCP has submitted to the Alliance.
For the following scenarios, members must meet the criteria and have already been referred to PCP case management, Alliance Case Management or an Enhanced Care Management (ECM) provider. (Note: providers can refer members via our Care Management Referral form and Enhanced Care Management referral process, respectively.)
A member repeatedly requests orders (e.g. medication, imaging, referrals) that the PCP determines is not medically necessary.
The member refuses to comply with the PCP’s recommended treatment, and the PCP believes the refusal endangers the health of the member or significantly aggravates a medical condition.
There has been an irremediable breakdown of the physician/patient relationship such that ongoing effective communication and patient care is impossible.
The member fails to keep three or more scheduled appointments with the PCP within a rolling 12-month period. Evidence of failure to keep appointments is required for this request, along with any PCP documentation regarding member outreach/reasons why member failed to keep appointments.
Other circumstances, supported by documentation, not identified herein that the PCP believes justify the reassignment of the member from their practice to a different PCP.
Inappropriate reasons to request reassignment
- Minor disruptive or verbally inappropriate behavior to provider or staff.
- The member’s disagreement with a provider’s recommended course of treatment, where such disagreement does not endanger the health of the member or significantly aggravate a medical condition. Members have the right to refuse treatment and obtain a second opinion.
- The member has filed a complaint regarding the provider or the provider’s office staff.
Immediate member reassignment requests
Reassignment requests are not automatically approved. They are presented to the Member Reassignment Committee (MRC) twice a month for review and discussion, ensuring appropriate interventions for members while providing support to providers. This work is carried out in collaboration with the Alliance’s Medical Director and the Care Management, Provider Relations and Member Services departments.
However, a PCP may request that a reassignment become effective immediately if there is:
- Member fraud or theft: The PCP alleges that the member has committed theft from the practice with documentation of a filed police report. If no police report has been filed, then the request will proceed under the standard review timeframe.
- Abusive/disruptive behavior by member: The PCP alleges that the member behaves in a threatening, abusive or disruptive manner to provider or office personnel with serious threat or commission of actual bodily harm or property damage, with documentation of a filed police report. If no police report has been filed, then request will proceed under the standard review timeframe.
In these instances, the Provider Relations Representative (PRR) obtains a written statement from the PCP, along with report number or online confirmation of police report, and contacts the Member Services Representative (MSR) to change the member’s status immediately to administrative for the remainder of the month before the request is brought to MRC for review.
Member Reassignment Threshold and Care-Based Incentive Program
Requests to reassign members have the potential to impact the PCP’s Care-Based Incentive (CBI) award. If a CBI provider reassigns members at a rate higher than one reassignment per 150 eligible members linked to the requesting CBI provider, points awarded to the CBI provider under the CBI Programmatic Incentive will be reduced by fifty percent (50%).
Providers requesting reassignment may not see the reassignment resolution in their membership until later, once the MRC has investigated the request. Therefore, reassignment may reflect on the practice profile for the following quarter or CBI program year. Thus, it may affect a different time period than when the request was made.
The Member Reassignment Threshold is not applied if the CBI provider has either:
- Less than an average of one hundred (100) eligible members, as determined by the number of months for which the CBI provider was contracted during the measurement period.
- Less than one hundred (100) eligible members as of the end of the CBI calendar year.
Members reassigned for the following reasons will not impact the PCP’s incentive as it pertains to the Member Reassignment Threshold measure:
- Alleged/actual fraud or theft.
- Alleged abusive/disruptive behavior.
- Violation of Medication Management Agreement.
- Members aging out of current PCP practice.
- Members requesting different PCP.
- Non-Medi-Cal member reassignments.
In addition, the following reasons for PCP reassignment can be considered for no impact to the Member Reassignment Threshold measure.
- Request for non-medically necessary orders.
- Non-compliance with treatment plan.
- Ineffective relationship.
- Failure to keep appointment.
Members must meet the criteria (review the definitions in the “Appropriate reasons for member reassignment” section of this page) and the provider must include documentation that the member has already been referred to/ is working with PCP case management, Alliance Case Management or an Enhanced Care Management (ECM) provider.
Reassignment for multiple sites
When a provider has multiple sites under one contract, the Alliance’s approval of member reassignment from one site does not prevent reassignment to any of the provider’s other sites. This is to balance the provider’s needs with the members’ right to access health care.
The exception would be if a member is reassigned for either:
- Member fraud or theft.
- Abusive/disruptive behavior by member.
In these instances, the provider may request to prevent the member’s reassignment to any of the provider’s other primary care and/or urgent care sites with a single reassignment request.
If a member is reassigned for any other reason, the Reassignment Committee will review if there are other primary care provider entities who are taking new patients within 10 miles or 30 minutes from the beneficiary's place of residence, as per California Code WIC § 14197. If there are such open panel providers, then the Member Services Representative will work with the member to select a new PCP, effective on the first of the following month after the Reassignment Meeting when the decision was made.
If there are no available open panel providers that meet California Code WIC § 14197 requirements, then the member may be offered reassignment to a different site location within the same original provider group to ensure that the member retains access to health care services.
Procedure to request member reassignment
1. Send written notification to the member.
PCP must notify member of desire for member reassignment at least one week before contacting Alliance for member reassignment request.
- The purpose of sending written notification is to advise the member that you are taking the steps necessary to begin the reassignment process with the Alliance.
- A letter must be sent for each member you seek to have reassigned (reassignment of one person from a family does not automatically reassign the entire family).
- Customizable letters are available for providers to fill out and send to members. These letters are available in English, Spanish and Hmong.
2. Complete a Request for Member Reassignment form.
A Request for Member Reassignment form (below) must be completed for each member you seek to have reassigned. Reassignment of one person from a family does not automatically reassign the entire family. The form allows space for a narrative description of events leading to your request.
- Be sure to give specific information (e.g., dates of missed appointments, an explanation of a patient’s abusive behavior, a copy of the Medication Management Agreement) as well as your efforts to correct the problem with the patient.
- Your request may be delayed or denied if it does not contain specific information and/or documentation about the circumstances that led to the request.
3. Send the Request for Member Reassignment form to Provider Services.
Please complete and submit the form below. You also have the option to print it and send it by fax to 831-430-5857.
Processing a member reassignment request involves the following steps:
- Review of Request for Member Reassignment form for completeness, accuracy and appropriate details.
- The Alliance will outreach to the member to obtain the member’s version of the events and provide any additional education, as needed.
- Alliance Medical Director reviews case on whether to approve, defer or deny request.
- The Alliance sends verbal or written notification to the requesting provider to close the loop on the reassignment request.
- The Alliance notifies the member regarding reassignment decision and assists the member to choose a new PCP as needed.
The member will remain linked to your practice until the Alliance approves the request. If the request is approved, the member remains linked until the effective date, and the Alliance notifies the requesting PCP by email.
The member will remain linked to your practice until the effective date indicated verbally or in writing from the Alliance. Until that date, you are required to ensure access to care by providing it yourself or referring the member out to another provider. Ensuring access to care includes prescribing or writing refills for any medically necessary notifications for the member. In addition, you are responsible for authorizing any specialty care services that the member may require until the effective date of reassignment.
If your request is approved, typically the effective date of the reassignment is the first day of the month following the date your request is approved and processed by the Alliance. However, the Alliance may determine a later effective date to allow adequate time for internal processing and for contacting the member so that he/she may select another primary care provider.
If you have questions regarding the reassignment process, please call a Provider Services Representative at 800-700-3874, ext. 5504.
Important note: The Alliance is accountable to state and federal regulatory agencies to ensure that physicians do not inappropriately terminate care to patients. Alliance members have the right to file a complaint if they perceive they were treated unfairly.
Contact Provider Services
| General | 831-430-5504 |
| Claims Billing questions, claims status, general claims information |
831-430-5503 |
| Authorizations General authorization information or questions |
831-430-5506 |
| Authorization Status Checking the status of submitted authorizations |
831-430-5511 |
| Pharmacy Authorizations, general pharmacy information or questions |
831-430-5507 |
Provider Resources
Latest Provider News
