Claims

Alliance providers are encouraged to use the Provider Portal for claims inquiries. If you have questions about TotalCare (HMO D-SNP), please review the TotalCare Billing FAQs section of this page. If there are any additional questions, contact the Claims Department Monday – Friday, 8:30 a.m. to 4:30 p.m. (closed 11:30 a.m. to 12:30 p.m. for lunch).

Phone:

• 831-430-5503
• 800-700-3874, ext. 5503 then Option 1 for Medi-Cal/IHSS, Option 2 for Behavioral Health or Option 3 for TotalCare.

When calling about questions on a claim, please have the following information available:

• The Alliance Claims Control Number (CCN) and/or the member’s Alliance ID number (if the inquiry is regarding a newborn claim billed under the mother’s ID number, please indicate this at the beginning of the call).
• Date of service.
• Dollar amount billed.
• Date claim was sent to Alliance.
• Provider NPI.

Paper claims should be mailed to the Alliance using the following addresses.

Medi-Cal claims (including Medi-Cal members with CCS eligibility)
ATTN: CLAIMS
Central California Alliance for Health
PO Box 660015
Scotts Valley, CA 95067-0015

In-Home Supportive Services (IHSS) or TotalCare claims
ATTN: CLAIMS
Central California Alliance for Health
1600 Green Hills Road, Suite 101
Scotts Valley, CA 95066

If you are interested in submitting electronic claims, complete the EDI Claims Enrollment Form. Contact the EDI Support Team for more information.

• EDI Claims Enrollment Form
• EDI Claims Enrollment Form Instructions
• EDI Companion Guide - Transaction Instruction
• EDI Companion Guide - 837/835 Trading Partner Information
• EDI Companion Guide - 276/277 Information
• EDI Companion Guide - 270/271 Information
• Realtime Transaction EDI System Password Reset 

Note: The Alliance's SFTP server will be offline the second Saturday of every month from 2 to 5 p.m. During this time, trade partners may not be able to submit EDI files or download acknowledgment files.

Resources to better acquaint you with the Remittance Advice (RA) generated by the Alliance partner CHC/ECHO.

• Remittance Advice Guide
• Remittance Advice Explain Codes

• Pass Through/Supplemental Payments FAQ
• Medi-Cal Targeted Rate Increases

Disclaimer: The Alliance is not affiliated with the external organizations listed below. Information on these pages is maintained by external entities and the Alliance is not responsible for their content.

• Find-A-Code
  Simple search for medical and health care billing codes online. Current codes, accurate information on ICD-9 (ICD-9-CM and ICD-9-PCS), ICD-10-CM/PCS, CPT(R), HCPCS, PQRI and other billing codes and code sets. A free trial is available.
• ICD-10 Code Search
  Mapping tool based on General Equivalency Mapping files published by CMS. Please note that this tool does not guarantee clinical accuracy, and clinical analysis may be needed to determine appropriate codes.
• ICD-10 Code Translator
  The ICD-10 code online translator tool allows you to compare ICD-9 to ICD-10 codes. ICD-9 was expanded from 17,000 to approximately 141,000 ICD-10 codes, and this online tool can help you map that expansion. (Note: this tool only converts ICD-10-CM codes, not ICD-10-PCS.)

Useful CMS Resources

• ICD-10 Main Website
• Industry Email Updates
• Provider Resources Page
• Latest News

ICD-10 Educational Videos from CMS

ICD-10 Basics

Training to Assist Small Physicians

Practice Manager's Guide to ICD-10

Other External Resources

• DHCS Reference Page
• AHIMA - The American Health Information Management Association