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Provider Manual

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New & Retired Alliance Provider Manual Policies

Policy Number	Title	Status	Approval Date
300-1509	Timely Access to Care	Approved	7/10/2025
300-8030	Monitoring Network Compliance with Accessibility Standards	Approved	7/10/2025
405-1318	Pediatric Complex Case Management	Approved	7/10/2025
404-1727	Provision of Telehealth Services to Alliance Members	Approved	7/2/2025
404-1114	Continuity of Care for Alliance Medi-Cal Members	Approved	7/1/2025
404-1307	Medical Second Opinions	Approved	7/1/2025
404-1401	Sterilization Consent Protocol	Approved	7/1/2025
404-1749	Continuity of Care for IHSS Members	Approved	7/1/2025
404-1749	Attachment A-Continuity of Care for IHSS Members	Approved	7/1/2025
404-1102	Inpatient Review	Approved	6/30/2025
404-1109	Disclosure of Utilization Management Process to Providers, Members and the Public	Approved	6/30/2025
404-1113	External Independent Medical Review	Approved	6/30/2025
404-1149	Medical Nutrition Therapy	Approved	6/30/2025
404-1201	Authorization Request Process	Approved	6/30/2025
405-1315	Children with Special Health Care Needs (CSHCN)	Approved	6/30/2025
403-1152	Site of Care	Approved	6/26/2025
404-1306	Extended and Standing Referral Authorizations	Approved	6/26/2025
405-1112	Care Management of Seniors and Persons with Disabilities for Medi-Cal	Approved	6/26/2025
403-1114	Continuing Pharmacy Care for New Members	Approved	6/23/2025
403-1126	Pharmaceutical Services Access	Approved	6/23/2025
403-1145	Pharmacy 340B Program	Approved	6/23/2025
300-3090	Attachment A - Provider Manual Update Flow Chart	Approved	6/16/2025
300-4025	Provider Screening and Enrollment Guidelines	Approved	6/13/2025
300-3090	Attachment B Quarterly Timeline	Approved	6/3/2025
404-1108	Monitoring of Over/Under Utilization of Services	Approved	6/3/2025
403-1156	Transition Process	Approved	5/30/2025
300-4035	Community Health Workers Requirements	Approved	5/21/2025
404-1202	After-Hours Availability of Plan or Contract Physician	Approved	5/20/2025
401-1521	Physical Accessibility Review	Approved	5/14/2025
401-3109	Comprehensive Tobacco Cessation Services	Approved	5/14/2025
300-8040	Monitoring PCP Capacity	Approved	5/12/2025
401-1201	Continuous Quality Improvement Committee	Approved	5/12/2025
401-1501	Standards of Care	Approved	5/12/2025
401-1502	Adult Preventive Care	Approved	5/12/2025
401-1502	Attachment A - Guidelines and Recommendations	Approved	5/12/2025
401-1511	Initial Health Appointment	Approved	5/12/2025
401-1519	Infection Control Practices	Approved	5/12/2025
401-1101	Quality and Performance Improvement Program	Approved	4/30/2025
404-1101	Utilization Management Program	Approved	4/28/2025
405-1319	Screening and Referral of Medically Eligible Children to CCS	Approved	4/28/2025
403-1103	Pharmacy Authorization Request Review Process	Approved	4/15/2025
404-1309	Member Access to Self Referred Services	Approved	4/15/2025
404-1520	Administrative Day Criteria	Approved	4/15/2025
404-1527	Palliative Care	Approved	4/15/2025
404-1310	Attachment A - Requirements for Referral of Members to Specialty Providers	Approved	4/8/2025
404-1720	Private Duty Nursing EPSDT Benefit	Approved	4/7/2025
404-1732	Meals and Lodging ("Maintenance") and Related Expenses for Members	Approved	4/7/2025
405-1313	Adult Complex Case Management	Approved	4/7/2025
404-1101	Utilization Management Program	Approved	3/31/2025
404-1708	Chiropractic Services for Alliance Members	Approved	3/31/2025
300-4195	Provider Training and Payment for Annual Cognitive Health Assessments	Approved	3/25/2025
404-1525	Skilled Nursing Program Policy for Medi-Cal	Approved	3/25/2025
404-1726	Non-Emergency Medical Transportation	Approved	3/25/2025
405-1317	Early Intervention Services	Approved	3/25/2025
404-1114	Continuity of Care	Approved	3/19/2025
405-1108	Medi-Cal Home and Community Based Services (HCBS) Waiver Programs	Approved	3/19/2025
404-1524	Long-Term Care for Medi-Cal Members	Approved	3/17/2025
408-1305	Behavioral Health Services	Approved	3/13/2025
408-1309	DHCS Non-Specialty Mental Health Services: Member Outreach, Education and Experience Requirements	Approved	3/13/2025
105-3003	Suspended or Ineligible Providers	Approved	3/12/2025
404-1108	Monitoring of Over/Under Utilization of Services	Approved	3/7/2025
200-5000	Administrative Member Status - Medi-Cal Members	Approved	2/28/2025
404-1724	Hospital Transportation from PCP Office	Approved	2/28/2025
600-1001	Claims Processing	Approved	2/28/2025
600-1050	Implementation of Medi-Cal Rates	Approved	2/28/2025
403-1103	Pharmacy Authorization Request Review Process	Approved	2/26/2025
403-1141	Physician/Facility-Administered Drugs Requiring Prior Authorization	Approved	2/26/2025
403-1142	Biosimilars	Approved	2/26/2025
403-1146	Drug Waste Reimbursement	Approved	2/26/2025
405-1318	Pediatric Complex Case Management	Approved	2/26/2025
405-1312	Primary Care Provider Responsibilities Including Case Management and the Promotion of Patient Centered Medical Home	Approved	2/25/2025
300-4025	Provider Screening and Enrollment Guidelines	Approved	2/20/2025
300-4045	Doula Requirements	Approved	2/19/2025
404-1307	Medical Second Opinions	Approved	2/19/2025
401-1101	Quality Improvement & Health Equity Transformation Program	Approved	1/22/2025
403-1136	Enteral Nutrition Products	Approved	1/22/2025
404-1102	Inpatient Review	Approved	1/22/2025
404-1710	Pediatric Therapies for Medi-Cal Recipients	Approved	1/22/2025
404-1714	Technology Assessment	Approved	1/22/2025
404-1109	Disclosure of Utilization Management Process to Providers, Members and the Public	Approved	1/21/2025
404-1702	Provision of Family Planning Services to Members	Approved	1/16/2025
404-1731	Medication Assisted Treatment	Approved	1/16/2025
404-1738	Community Health Worker Services	Approved	1/16/2025
401-1505	Childhood Preventive Care	Approved	1/14/2025
401-1505	Attachment A - AAP Recommendations for Preventive Pediatric Health Care	Approved	1/14/2025
401-1505	Attachment B - CA Pediatric TB Risk Assessment	Approved	1/14/2025
401-1506	Immunization Services and Reimbursement	Approved	1/14/2025
401-1515	Nurse Midwife Scope of Practice and Supervision	Approved	1/14/2025
404-1201	Authorization Request Process	Approved	1/10/2025
404-1309	Member Access to Self Referred Services	Approved	1/8/2025
404-1303	Referral Consultation Request Process	Approved	12/30/2024
460-1308	Enhanced Care Management Overview	Approved	12/30/2024
600-1017	Provider Inquiry and Dispute Resolution	Approved	12/30/2024
600-1040	Unbundled ENT CPT Codes	Approved	12/30/2024
600-1050	Implementation of Medi-Cal Rates	Approved	12/30/2024
600-1072	AB72	Approved	12/30/2024
600-2307	Telehealth Covered Services and Reimbursement	Approved	12/30/2024
600-2308	Family Planning Supplemental Payment Eligibility and Payments	Approved	12/30/2024
600-2314	Proposition 56 Directed Payment Programs Policy	Approved	12/30/2024
300-4103	Fair Hearing Process for Adverse Decisions	Approved	12/23/2024
404-1524	Long-Term Care for Medi-Cal Members	Approved	12/23/2024
404-1525	Skilled Nursing Program Policy for Medi-Cal	Approved	12/23/2024
404-1525	Attachment A - Skilled Nursing Facility Levels of Care Matrix	Approved	12/23/2024
404-1527	Palliative Care	Approved	12/23/2024
404-1726	Non-Emergency Medical Transportation	Approved	12/23/2024
300-9010	Review Procedure for Decisions Concerning Provider Network Participation	Approved	12/20/2024
401-1301	Potential Quality Issue Review Process	Approved	12/20/2024
401-1306	Corrective Action Plan for Quality Issues	Approved	12/20/2024
401-1502	Adult Preventive Care	Approved	12/20/2024
404-1203	Surgical Treament of Varicose Veins	Approved	12/20/2024
300-4180	Training and Payment for Adverse Childhood Experiences Screening	Approved	12/16/2024
300-6030	New Provider Training	Approved	12/16/2024
300-6036	Provider Early and Periodic Screening Diagnostic and Treatment (EPSDT) Training	Approved	12/16/2024
300-1509	Timely Access to Care	Approved	12/13/2024
300-4160	Optometrist Reimbursement for Medical Services	Approved	12/13/2024
300-8030	Monitoring Network Compliance with Accessibility Standards	Approved	12/13/2024
404-1603	Medical Supplies Authorizations	Approved	12/13/2024
404-1715	Genetic Testing	Approved	12/13/2024
404-1601	Durable Medical Equipment (DME) Authorization	Approved	12/10/2024
404-1703	Alliance Members with Veterans Benefits	Approved	12/10/2024
404-1112	Medical Necessity - The Definition and Application of Medical Necessity Provision to Authorization Requests	Approved	12/5/2024
105-3002	Program Integrity: Special Investigations Unit Operations	Approved	12/4/2024
300-4025	Provider Screening and Enrollment Guidelines	Approved	11/15/2024
404-1310	Attachment A - Requirements for Referral of Members to Specialty Providers	Approved	11/7/2024
404-1710	Pediatric Therapies for Medi-Cal Recipients	Approved	11/7/2024
404-1731	Medication Assisted Treatment	Approved	11/7/2024
600-1802	Claims Submission Guidelines and Rental Timeframes for TENS Device	Approved	11/7/2024
600-1803	Claims Submission Guidelines and Rental Timeframes for Wheelchairs	Approved	11/7/2024
600-1804	Claims Submission Guidelines for an Osteogenesis Stimulator	Approved	11/7/2024
404-1601	Attachment A - DME Authorization Matrix Providers	Approved	11/4/2024

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