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- Kev Pab Kho Cwj Pwm
- California Cov Kev Pab Cuam Rau Menyuam Yaus (California Children’s Services)
- Promoting Cultural and Linguistic Competency
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- Pharmacy Directory
- Pharmacy Formulary
- Formulary Changes for 2021
- Prescription Drug Prior Authorization
- Prior Authorization Criteria
- Anti-Obesity Agents Form
- Prior Authorization Information Request for Injectable Drugs
- Hepatitis C virus (HCV) Prior Authorization Checklist
- High Dose Opioid Regimen Checklist
- Synagis Statement of Medical Necessity
- Tobacco Treatment Checklist
- Treatment Authorization Request (TAR)
- Medical Nutrition Therapy Benefit Quick Reference Guide
- Pharmacy Home Program General Information and Enrollment Form
- Formulary Diabetic Testing Supplies Quick Reference Guide
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- Care-Based Incentive (CBI) Summary
- CBI Technical Specifications
- Antidepressant Medication Management Tip Sheet
- Immunizations: Adult Tip Sheet
- Immunizations: Adolescents Tip Sheet
- Programmatic Measure Benchmarks & Performance Improvement
- Asthma Medication Ratio Tip Sheet
- 90-Day Referral Completion – Exploratory Tip Sheet
- Antidepressant Medication Management Tip Sheet
- Application of Fluoride Varnish Tip Sheet
- Immunizations: Children (Combo 10) Tip Sheet
- Chlamydia Screening in Women – Exploratory Measure Tip Sheet
- Child and Adolescent Well-Care Visits Tip Sheet
- Cervical Cancer Screening Tip Sheet
- Child and Adolescents BMI Assessment Tip Sheet
- Breast Cancer Screening – Exploratory Measure Tip Sheet
- Well-Child Visits in the First 15 Months of Life Tip Sheet
- Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet
- Tuberculosis (TB) Risk Assessment – Exploratory Tip Sheet
- Preventable Emergency Visits Tip Sheet
- Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet
- Maternity Care: Prenatal Tip Sheet
- Maternity Care: Postpartum Tip Sheet
- Plan All-Cause Readmissions Tip Sheet
- Lead Screening in Children – Exploratory Measure Tip Sheet
- Initial Health Assessment Tip Sheet
- Diabetic HbA1c Poor Control >9% Tip Sheet
- Developmental Screening in the First 3 Years Tip Sheet
- Controlling High Blood Pressure – Exploratory Measure Tip Sheet
- Immunizations: Children (Combo 10) Tip Sheet
- Best Practices for Reducing Patient No-Shows Tip Sheet
- Ambulatory Care Sensitive Admissions Tip Sheet
- Depression Tool Kit
- USPSTF Recommendations for Primary Care Practice
- Emergency Care Visit Diagnosis
- Blood Lead Testing Flyer
- California Management Guidelines: Childhood Lead Poisoning
- Standard of Care Guidelines: Childhood Lead Poisoning
- What’s New
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- Immunization Resources
- Cov Kev Txhawb Zog Rau Tus Tswvcuab
- Cov Kev Them Nyiaj Raws Tus Nqi
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- Kev Pab Kho Cwj Pwm
- California Cov Kev Pab Cuam Rau Menyuam Yaus (California Children’s Services)
- Promoting Cultural and Linguistic Competency
-
- Pharmacy Directory
- Pharmacy Formulary
- Formulary Changes for 2021
- Prescription Drug Prior Authorization
- Prior Authorization Criteria
- Anti-Obesity Agents Form
- Prior Authorization Information Request for Injectable Drugs
- Hepatitis C virus (HCV) Prior Authorization Checklist
- High Dose Opioid Regimen Checklist
- Synagis Statement of Medical Necessity
- Tobacco Treatment Checklist
- Treatment Authorization Request (TAR)
- Medical Nutrition Therapy Benefit Quick Reference Guide
- Pharmacy Home Program General Information and Enrollment Form
- Formulary Diabetic Testing Supplies Quick Reference Guide
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-
-
- Care-Based Incentive (CBI) Summary
- CBI Technical Specifications
- Antidepressant Medication Management Tip Sheet
- Immunizations: Adult Tip Sheet
- Immunizations: Adolescents Tip Sheet
- Programmatic Measure Benchmarks & Performance Improvement
- Asthma Medication Ratio Tip Sheet
- 90-Day Referral Completion – Exploratory Tip Sheet
- Antidepressant Medication Management Tip Sheet
- Application of Fluoride Varnish Tip Sheet
- Immunizations: Children (Combo 10) Tip Sheet
- Chlamydia Screening in Women – Exploratory Measure Tip Sheet
- Child and Adolescent Well-Care Visits Tip Sheet
- Cervical Cancer Screening Tip Sheet
- Child and Adolescents BMI Assessment Tip Sheet
- Breast Cancer Screening – Exploratory Measure Tip Sheet
- Well-Child Visits in the First 15 Months of Life Tip Sheet
- Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet
- Tuberculosis (TB) Risk Assessment – Exploratory Tip Sheet
- Preventable Emergency Visits Tip Sheet
- Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet
- Maternity Care: Prenatal Tip Sheet
- Maternity Care: Postpartum Tip Sheet
- Plan All-Cause Readmissions Tip Sheet
- Lead Screening in Children – Exploratory Measure Tip Sheet
- Initial Health Assessment Tip Sheet
- Diabetic HbA1c Poor Control >9% Tip Sheet
- Developmental Screening in the First 3 Years Tip Sheet
- Controlling High Blood Pressure – Exploratory Measure Tip Sheet
- Immunizations: Children (Combo 10) Tip Sheet
- Best Practices for Reducing Patient No-Shows Tip Sheet
- Ambulatory Care Sensitive Admissions Tip Sheet
- Depression Tool Kit
- USPSTF Recommendations for Primary Care Practice
- Emergency Care Visit Diagnosis
- Blood Lead Testing Flyer
- California Management Guidelines: Childhood Lead Poisoning
- Standard of Care Guidelines: Childhood Lead Poisoning
- What’s New
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- Immunization Resources
- Cov Kev Txhawb Zog Rau Tus Tswvcuab
- Cov Kev Them Nyiaj Raws Tus Nqi
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Cov Kev Pab Cuam Tswvcuab
Ua ib Daim Ntawv Hais Kev Tsis Txaus Siab
Peb xav kom koj zoo siab nrog koj cov kev pab saib xyuas kev noj qab haus huv thiab peb cov kev pab cuam. Yog tias koj tsis txaus siab, koj tuaj yeem qhia peb los ntawm kev ua ib daim ntawv hais kev tsis txaus siab, kuj hu ua kev tsis txaus siab. Peb tuaj yeem pab koj daws teeb meem uas tej zaum koj yuav muaj nrog ib tus kws kho mob, nrog rau lub Alliance lossis nrog kev txais tau cov khoom siv kho mob uas koj xav tau.
Koj muaj txoj cai sau tiav ib daim ntawv hais kev tsis txaus siab txog tej yam xws li:
- Kev tau tos kom ntev ntev mam li ntsib tau ib tus kws kho mob lossis mamli teem tau sijhawm mus ntsib.
- Hom kev saib xyuas uas koj tau txais los ntawm koj tus kws kho mob lossis txoj kev uas koj tau txais kev kho mob li cas hauv chaw ua haujlwm.
- Kev raug tsub nqi lossis hais kom them rau cov kev pab cuam uas koj xav tias yuav tsum raug them los ntawm lub Alliance.
- Ib qho kev txiav txim siab uas peb tau txiav txim siab hloov lossis tsis kam muab cov kev pab cuam.
Peb cov neeg ua haujlwm tuaj yeem pab koj sau tiav ib daim ntawv hais kev tsis txaus siab (kev tsis txaus siab) lossis rau ib qhov kev thov kom rov hais dua. Ib qho kev thov kom rov hais dua yog kev tsis txaus siab nrog lub Alliance txoj kev txiav txim siab. Kev pab txhais lus muaj thaum koj ua ib daim ntawv hais kev tsis txaus siab lossis thov kom rov hais dua. Koj kuj tseem tuaj yeem muaj ib tus neeg hauv tsev neeg lossis tus phooj ywg pab koj sau tiav koj ib daim ntawv hais kev tsis txaus siab. Peb xav tiv thaiv koj cov cai. Kev hais tawm qhov kev txhawj xeeb lossis kev sau tiav ib daim ntawv hais kev tsis txaus siab yuav tsis cuam tshuam dabtsi rau koj cov kev txais kev pab kho mob. Koj tus kws kho mob tseem yuav cais tsis tau koj vim koj tau sau tiav ib daim ntawv hais kev tsis txaus siab.
Yuav kom muaj kev nyab xeeb ntawm peb cov tswvcuab thiab cov neeg ua haujlwm, thiab kom ua raws li cov lus qhia los ntawm lub chaw muab kev noj qab haus huv rau zej zog pej xeem, lub Alliance yuav tsis muaj kev sib tham tim ntsej tim muag ntawm peb cov chaw ua haujlwm thaum lub sijhawm muaj kev sib kis ntawm tus kab mob COVID-19. Txawm li cas los xij, lub Alliance cog lus yuav muab kev pab cuam raws li koj xav tau nyob rau lub sijhawm no.
Yog tias koj tsis txaus siab nrog ib tus kws muab kev pab kho mob lossis lub chaw kho mob, nws zoo tshaj yog tias koj nrog lawv tham ua ntej. Qhia rau ib tus neeg hauv lub chav ua haujlwm paub txog yam tshwm sim sai li sai tau. Hais kom nws los pab kho qhov teeb meem ntawd. Lub Alliance yuav nyob ntawm no los pab koj, yog li ntawd thov hu rau peb yog xav tau kev pab.
Yog tias koj tsis txaus siab rau qhov kev pab kho mob uas koj tau txais nyob hauv ib lub tsev kho mob loj lossis lwm qhov chaw, koj tuaj yeem thov kom tham nrog ib tus neeg kws tu neeg mob, tus neeg ua haujlwm pab cuam neeg zej zog lossis tus neeg sawv cev rau cov neeg mob. Tom qab ntawd, hu rau lub Alliance es peb thiaj tuaj yeem pab tau koj.
Yog tias koj tau txais ib daim nqi kho mob uas raug pab them los ntawm lub Alliance, hu rau tus xov tooj ntawm lub tuam tsev them nqi uas nyob rau ntawm daim ntawv. Qhia rau lawv paub tias koj muaj lub Alliance raws li koj qhov kev fajseeb kho mob thiab hais kom lawv xa ib qho kev thov rau yam kev pab kho mob ua lawv tau muab rau koj tuaj ncaj qha rau peb. Tom qab ntawd, hu rau peb tam sim ntawd. Qhia peb tus nqi, hnub time uas tau txais kev pab kho mob thiab vim li cas koj thiaj li txais tus nqi yog li ntawm peb thiaj li pab tau koj.
Nws tsis muaj sijhawm txwv los sau tiav ib daim ntawv hais kev tsis txaus siab, tab sis peb xav txhawb kom koj ua ib daim ntawv ze rau ntawm hnub time uas koj muaj qhov txhawj xeeb ntawd. Yog tias lub Alliance tau tsis kam rau koj txoj kev pab cuam uas kom tau thov rau thiab koj tsis pom zoo nrog qhov kev txiav txim siab ntawd koj tuaj yeem sau tiav ib daim ntawv thov rov hais dua. Ib qho kev thov kom rov hais dua muaj lub sijhawm txwv thiab yuav tsum sau tiav kom tsis pub dhau 60 hnub suav txij hnub uas txiav txim.
Muaj ntau txoj kev los sau tiav ib daim ntawv hais kev tsis txaus siab lossis kev thov kom rov hais dua:
- Hu xov tooj: Hu Rau Lub Chaw Pab Cuam Tswvcuab. Muab rau peb koj tus lej Alliance ID, koj lub npe thiab qhia tias vim li cas koj tsis txaus siab.
- Kev xa ntawv: Hu Rau Lub Chaw Pab Cuam Tswvcuab thiab hais kom lawv xa ib daim foos tuaj rau koj. Koj tseem tuaj yeem tau txais ib daim foos hais kev tsis txaus siab los ntawm koj tus kws kho mob lub chaw haujlwm. Sau koj lub npe, koj tus lej Alliance ID, thiab qhia tias vim li cas koj thiaj li tsis txaus siab rau daim foos.
Xa daim ntawv foos mus rau:
Grievance Unit
1600 Green Hills Road, Suite 101
Scotts Valley, CA 95066
- Saum oos lais (online): Sau tiav hauv oos lais (online) Daim Ntawv Ua Hais Kev Tsis Txaus Siab.
- Tim Ntsej Tim Muag: Mus rau peb lub chav haujlwm los tham tim ntsej tim muag nrog ib tus neeg sawv cev txog koj li kev tsis txaus siab.
- Tus Kws Kho Mob Lub Chaw Haujwm: Koj tuaj yeem ua ib qho kev hais kev tsis txaus siab ncaj qha nrog rau koj tus kws kho mob lub chaw haujlwm.
Koj tuaj yeem thov rau ib qhov kev tshuaj xyuas sai, lossis tshuaj xyuas sai-sai, yog koj xav tias lub Alliance tsis kam rau ib qho kev thov uas yog ib qho xwmtxheej ceev lossis yuav ua ib qho kev mob loj heev rau koj li kev noj qab haus huv. Qhov no tuaj yeem suav nrog, tab sis tsis txwv rau, kev mob hnyav, kev ua kom lub neej ploj, kev mob nqaj lossis lub cev ntaj ntsug. Yog tias koj qhov kev hais kev tsis txaus siab tsim nyog, peb yuav daws nws tsis pub dhau 72 teev txij thaum tau txais.
Thaum peb tau txais koj qhov kev hais kev tsis txaus siab rau hauv lub sijhawm tsis pub dhau 5 hnub, peb mam li xa ib daim ntawv tuaj qhia rau koj tias peb tau txais koj daim ntawv lawm. Hauv lub sijhawm tsis pub dhau 30 hnub, peb yuav xa ib tsab ntawv ntxiv ua qhia rau koj tias peb tau daws koj qhov teeb meem li cas lawm. Kom nug txog seb koj qhov kev hais kev tsis txaus siab tau ua li cas, thov hu los tham nrog tus neeg ua haujlwm txog Kev Hais Kev Tsis Txaus Siab. Yog tias koj tseem tsis txaus siab tom qab peb tau daws koj qhov teeb meem tas, peb yuav qhia koj tias koj yuav ua tau dab tsi ntxiv mus.
Yog koj xav tias lub Alliance lossis tus kws kho mob tsis hwm koj txoj kev tsis pub lwm tus paub txog koj, koj muaj cai sau ib daim ntawv hais kev tsis txaus siab mus rau Lub Tuam Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv thiab Kev Pab Pej Xeem (Department of Health and Human Services) rau lub sijhawm twg los ntawm kev tiv tauj rau:
Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue SW
Room 509F, HHH Building
Washington, DC, 20201
Lub Xeev Lub Tuam Tsev Haujlwm Pab Daws Teeb Meeb (State Office of the Ombudsman) yuav pab Medi-Cal cov tswvcuab uas muaj teebmeem nrog lawv txoj kev npaj kho mob. Koj tuaj yeem hu rau lawv tus xov tooj hu dawb ntawm 888-452-8609.
Koj kuj tuaj yeem hu rau California Lub Tuam Tsev Tswj Kev Pab Kho Mob (California Department of Managed Health Care).
California Department of Managed Health Care Statement
The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan at (800) 700-3874 or TDD (877) 548-0857 and use your health plan’s grievance process before contacting the department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you. If you need help with a grievance involving an emergency, a grievance that has not been satisfactorily resolved by your health plan, or a grievance that has remained unresolved for more than 30 days, you may call the department for assistance. You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of medical decisions made by a health plan related to the medical necessity of a proposed service or treatment, coverage decisions for treatments that are experimental or investigational in nature and payment disputes for emergency or urgent medical services. The department also has a toll-free telephone number (1-888-466-2219) and a TDD line (1-877-688-9891) for the hearing and speech impaired. The department’s internet website www.dmhc.ca.gov has complaint forms, IMR application forms, and instructions online.
Hu Rau Pab Neeg Saib Xyuas Kev Tsis Txaus Siab
Tus Xov Tooj hu dawb: 800-700-3874
Hauv Cheeb Tsam: 831-430-5816
TTY: 877-548-0857
Tus Xov Tooj Xa Ntawv (Fax): 831-430-5579
Hnub Monday-hnub Friday, 8 a.m. txog 5 p.m.
Kev Txais Tau Alliance Cov Kev Pab Cuam
Xov Xwm Tseeb
Healthier Living Program
Medical Device Recall for Sleep and Breathing Devices
June 2021 – Member Newsletter
Expanded Medi-Cal coverage for young adults
March 2021 – Member Newsletter
Hu Tuaj Rau Peb | Hu Dawb: 800-700-3874
Lub Alliance
© 2021 Central California Alliance for Health