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2025 CBI Workshop Frequently Asked Questions

ACEs

We are receiving denied claims for ACE screenings and we are not sure why.

If a new provider joins our clinic and already completed ACEs training, how do we confirm their training and attestation date?

Fluoride Varnish

Are dental claims included in the Application of Dental Fluoride measure?

Well-Child Visit

Are we supposed to complete child well visits every 14 days or once a month?

Women’s Health

How do clinics report when patients refuse their pap or chlamydia screenings?

Initial Health Appointment (IHA)

If a patient refused their IHA because they are receiving care elsewhere, do we still need to make three attempts to schedule them with us or can we just use the IHA dummy code?

If a patient already established care and is new to Medi-Cal and in need of an IHA per the Alliance, does the provider need to code the past established visit per Alliance requirements, or can they submit the IHA dummy code?

The provider does not have to go back and recode or rebill the visit. The IHA visit does not need to be scheduled if all the elements required are present in the previous visit(s). Please submit the dummy code via the Data Submission Tool (DST). As a reminder, all dummy code submissions are subject to audit and documentation must be present in the member's chart. For a list of required elements for the IHA, please see How to meet Initial Health Appointment requirements. For more information on the measure, coding requirements and data submission, please see our IHA Tip Sheet.

Immunizations

How do we remove a member from a care gap list or measure population if they continue to refuse vaccines?

Depression Screening

Where do we find the depression screening codes to use?

Data Submission Tool

How do we know what measures can be submitted in the Data Submission Tool?

When is the last day to submit claims for CBI?

The last day to submit claims for CBI is Jan. 31 of the following year. For CBI 2025, the last day to submit claims is Jan. 31, 2026. The deadline to submit supplemental data for CBI 2025 is Feb. 28, 2026. We highly recommend uploading data to the DST monthly, or at minimum quarterly, to ensure your data is captured and allow you to track your clinic’s performance throughout the program year.

Why can’t we see the data we uploaded into the DST in our reports?

The Alliance tries to export and run the measure data around the same time of the month, but this may vary due to holidays or where business days land in the month. Generally, if you submit data before the 25^th of the month, you should see that data in next month’s quality report. For example, if you submitted before Oct. 25, that data displays in the November reports. If you submit data on or after Oct. 25, that data displays in the December reports.

How do we access the Provider Portal and where can we find reports and the DST?

Please view the CBI introduction video, which includes information on reports (33:20) and the Data Submission Tool (40:30). If you are new to the clinic and need access to the portal, you can either complete the Provider Portal Account Request Form or ask an administrator at your clinic to set up your account. The DST Guide, located in the Provider Portal, includes step-by-step instructions on how to submit your data.

Is the Data Submission Tool available for the new 2025 measures?

How do we submit results for the measures?

Why does our EHR show that we administered more vaccines than what is on our reports? We are uploading our data through the Data Submission Tool.

Data gaps can occur due to various factors, including incorrect dosing intervals, discrepancies between claims and registry data, and mismatched member information. To ensure accurate reporting, please verify immunization dates and submit your data through claims or the DST. If there are still concerns after your staff has investigated, please email us at [email protected] and cc your Provider Relations Representative. We will add your request to our queue and investigate the data.

Grants

For Workforce Recruitment grants, how many providers can we apply for at any given time? Do we apply each time we recruit a provider?

Workforce Recruitment grants provide funding to help health care and care-based organizations recruit and hire community health workers, doulas, MAs and more. There are four different types of Workforce Recruitment grants:

Provider Recruitment – New health care professionals for allied, behavioral/mental health, primary care and specialty providers.
Community Health Workers (CHW) - CHWs need to be or become qualified to provide the compensable CHW benefit to Medi-Cal members in Alliance service areas.
Medical Assistant – Funding to hire MAs in primary care practices.
Doula Recruitment Program - For the recruitment and first-year costs of doulas who are, or become, qualified to provide the compensable Doula Service Benefit to Medi-Cal members in the Alliance service area.

No more than three (3) Workforce Recruitment grants awarded for any of these four grant types may be open for recruitment at any one time (e.g., two previously awarded grants may be open for recruitment when a third new application is submitted). A grant is considered fulfilled (i.e., no longer open) when the Alliance receives the Part One payment request with required documentation indicating that the recruit was hired.

The grant program is a competitive process and grant awards are not guaranteed.

Can an organization apply for more than one funding opportunity (grant program)?

Is the $10K for language proficiency separate from the maximum award total or is it included in the provider recruitment award?

Can we apply for grant programs if we were awarded MCGP grants in the past?

An organization may apply for as many funding opportunities as they are eligible. However, there are a few considerations to keep in mind:

Organizational capacity to meet all grant requirements.
Grant applications are competitive, and approval of awards depends on funding availability.
You may only have one grant-funded project at a time under a specific program (e.g., do not apply for a new Healthcare Technology grant until an active grant is completed).

Provider Relations

Can we change a patient’s eligibility to admin member when they have primary insurance and the Alliance is secondary?

Training and Best Practices

We are onboarding primary care providers to our group with an effective date of Jan. 2, 2025. How do we ensure we are signed up for the correct measures?

We recommend contacting your Provider Relations Representative to ensure that you have a CBI contract in place. Your clinic qualifies for measures for which you have enough members. For Access Measures, if you have five members who need a particular service, you qualify for those measures. For example, if your clinic has five members who need a developmental screening, you qualify for that measure. With at least 100 members, you qualify for the Hospital and Outpatient measures. For Quality of Care measures, you qualify for the individual measure if there are at least 30 members that need that service. So, if your clinic has at least 30 members that need breast cancer screening, you qualify for that measure.

If a patient is assigned to our facility and is not established and we are unable to contact them, when can we remove them from our list?

How are members who are assigned to us seen at other clinics under the Alliance?

The member may:

Contact a provider to schedule an appointment for continuity of care.
Have other health coverage (OHC) that is active but not reported to the Alliance.
Use other clinics that have availability that meets the member's needs.
Not have provided their member ID or eligibility information and/or the provider did not verify eligibility and PCP assignment before seeing the member.

How is it possible for a patient to have duplicate member IDs – one assigned to one clinic and the other assigned to another clinic?

The issuance of a Medi-Cal ID starts at the Medi-Cal office level. Reasons may include:

Adoption, foster care, gender change or a HIPAA discrepancy. Two IDs are present (old/new) and the old one is not yet deactivated.
The member applied via the “Gateway” program at the hospital or provider office, and this is not updated at the county Medi-Cal office. The member reports it later, and accounts are not merged. This mainly happens with newborns. If a member has IHSS-CCAH Alliance Care (commercial plan), their member ID starts with the letter “B.” If a member has Alliance Medi-Cal, their member ID starts with the number 9.

Before a newborn receives their member ID, are we able to submit claims under the mother’s member ID?

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