COVID-19 Information for Providers
To address commonly asked questions from members, the Alliance has developed the COVID-19 webpage for members. We have also provided our member-facing staff with talking points to help them answer questions. We will continue to update these materials as new information becomes available.
Members are encouraged to contact their provider to discuss their symptoms and next steps. If members are unable to reach their provider, we are encouraging them to contact the Alliance's 24-hour Nurse Advice Line (NAL) to speak to a registered nurse. The number is 844-971-8907.
Members can receive a 90-day supply, including free standard delivery, for most prescription medications mailed to them through MedImpact Direct. To set up mail order for medications, members can visit the MedImpact Direct website or call 855-873-8739.
Additionally, the Alliance has added a few options to our pharmacy network, including SortPak, a mail order pharmacy.
To find an in-network pharmacy, use MedImpact's online pharmacy directory.
The Alliance is committed to delivering culturally and linguistically appropriate health care services to our diverse membership, especially during this time. The Alliance offers language assistance services at no cost to all eligible limited English proficiency (LEP) members or members who are deaf and/or hard of hearing when accessing Alliance-covered services. The Alliance offers two types of interpreting services that providers can access when communicating with Alliance members in our tri-county service areas:
- Telephone interpreter services are available to Alliance providers on a 24-hour basis at all key points of contact, including medical and non-medical care settings. No prior approval is required. Refer to the Alliance Interpreter Service Provider Quick Reference Guide for more information on how to access this service. We encourage our providers to continue utilizing the Alliance telephonic interpreting services when communicating with our members.
- On-site face-to-face interpreter services requests can be made by providers according to established criteria and timeframes. Prior approval is required. Please ensure requests are submitted to the Alliance in a timely manner for prior approval and to ensure timely coordination of service. Use the Face-to-Face Interpreter Service Form.
Visit the Cultural and Linguistic Services page to learn more about how to access these services for your patients. You can also call the Alliance Health Education Line at 800-700-3874, ext. 5580.
We’ll continue to monitor and work with our interpreting vendors to ensure the health and safety of their staff. If there are any changes to these services, providers will be notified immediately.
If members need hard copies of materials, Alliance staff will mail copies or send electronic links as requested.
We will work with our providers to ensure that we are supporting the provision of medically necessary care. We understand that some providers are providing patient consultations over the phone (including telehealth, if appropriate) to minimize potential virus exposure. See below for required codes for telehealth services.
- Existing face-to-face codes apply when a Medi-Cal provider/clinician is billing the Alliance for video/telephonic visits. Example codes for the PCP setting: 99201-99204, 99212-99214.
- The CPT or HCPCS code(s) must be billed using:
- Place of Service Code “02.”
- Use appropriate telehealth modifiers:
- Synchronous, interactive audio and telecommunications systems: Modifier 95.
- Asynchronous store and forward telecommunications systems: Modifier GQ.
For more information, see our provider news article covering additional guidance on telehealth services.
We stand with you during this unprecedented time and are here to answer any questions you may have. For assistance with billing and authorization, please call Provider Services.
As our members continue to be affected by the COVID-19 pandemic, you are likely busy screening patients and prescribing COVID-19 laboratory testing. We want you to know that the Alliance covers both laboratory testing and screening for COVID-19.
To ensure you receive appropriate reimbursement, you must submit COVID-19 related claims using the following procedure codes:
|U0001||2019-Novel Coronavirus [2019-nCoV diagnostic p]|
|U0002||COVID-19 lab test non-CDC|
|87635||SARS-COV-2 COVID-19 AMP PRB|
For a list of contracted labs, providers may reference the Alliance Provider Directory or contact their Provider Relations Representative.
The Department of Health Care Services (DHCS) has announced incentive opportunities for health plans to support members and providers in increasing COVID-19 vaccination rates. The first milestone that DHCS expects health plans to achieve is a 5% increase in COVID-19 vaccination rates by October 31, 2021.
In response to this opportunity, the Alliance will be offering both member and provider incentives for COVID-19 vaccination efforts, for services beginning in September 2021. While the specific details of the provider incentive are still being developed, we want to share the following high-level information:
- CalVax Enrollment Incentive: one-time payment for enrollment in CalVax to administer COVID-19 vaccinations.
- Per Member Vaccine Incentive: fee for service payment for each member who receives a COVID-19 vaccination (payment to be made to the primary care organization to whom the member is assigned at the time of vaccination).
- Panel-Based Vaccination Incentive: payment based on the total percentage of a primary care provider’s assigned panel who is vaccinated.
- (Potential/Under Consideration) One-Time Vaccination Support Incentive: one-time payment from the Alliance to support COVID-19 vaccination efforts, including outreach events, temporary staffing, and supplies.
In order to maximize these incentive opportunities, the Alliance encourages our Primary Care Providers to continue and enhance efforts to increase COVID-19 vaccination rates for Alliance members. If you have questions or would like additional support to engage members in receiving a COVID-19 vaccination, please contact our Provider Services team at 800-700-3874 ext. 5504.
We understand that providers are extremely busy as they focus on providing patient care. In order to support our providers in prioritizing member access to care and to follow public health guidelines, we have suspended in-person provider visits. All interactions and provider follow-up discussions will occur by webinar, phone and email. We will focus on supporting our providers in the most efficient way possible during this time.
Yes, we are maintaining business operations. Our mission is to ensure our members in Merced, Monterey and Santa Cruz counties continue to access needed health care. Over 375,000 Medi-Cal members rely on the services we provide, and our commitment to these people will not waver despite this public health crisis. However, to help reduce COVID-19 exposure, the public areas and member service counters for the Central California Alliance for Health are currently closed.
In order to protect the health of our workforce, we have transitioned to full time work from home for employees currently set up to work remotely. Fortunately, the Alliance already had a robust work-life balance program in place, allowing work from home opportunities for over three-quarters of our workforce. This approach has well prepared us to seamlessly support business operations and provide member and provider support in times of crisis. In addition, the Alliance has a business continuity plan in place to maintain business operations and continue providing core services in the event of a mandatory public health quarantine.
The Alliance will continue to follow public health guidelines to slow the spread of COVID-19 and ensure the health and safety of our members, staff and visitors. We will provide up-to-date information about our offices re-opening on our website and through direct provider communications.
We continue to monitor the situation by staying in touch with public health and government officials, and we are following their guidance as the situation continues to evolve.
This chart provides guidance on which COVID-19 vaccine is recommended for a patient, based on age or health conditions.
Quarantine vs. Isolation
- The Centers for Disease Control and Prevention (CDC) has published a flyer explaining COVID-19 quarantine and isolation.
- Suicide Prevention Tips for Health Care Providers
- Taking Care of Your Behavioral Health: Tips for social distancing, quarantine, and isolation during an infectious outbreak
- Emotional Wellness Toolkit
- Coping with stress during infectious disease outbreaks
- SAMHSA's Disaster Distress Helpline: The toll-free number is 800-985-5990 (English and Spanish).
- Criteria for admission to Stanford's LPCH Eating Disorders Program
- DHCS APL 20-022 – COVID 19 Vaccine Administration includes information about:
New DHCS requirements for visitors in acute health care and long-term care settings.
- The health care worker vaccine requirement.
- CDC COVID-19 One-Stop Shop Toolkits: includes resources for communicating COVID-19 information for various audiences and demographics.
Contact Provider Services
Billing questions, claims status, general claims information
General authorization information or questions
Checking the status of submitted authorizations
Authorizations, general pharmacy information or questions