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Provider Portal Frequently Asked Questions
Account Setup and Login
New Provider Portal accounts can be set up by logging into the portal from the Alliance provider website.
When you log into the existing portal, simply scroll down to see the username you currently use. If you have trouble remembering your username, please call the Provider Portal Support Specialist at 831-430-5518.
When you log in to the Provider Portal, there is a prompt to reset your password. As long as you know the username and email address used when setting up the account, you can easily reset your password.
Please call the Provider Portal Support Specialist at 831-430-5518.
If you have attempted to log in three times with the incorrect username and password, you will be locked out of your account. In order to reset your account, please contact the Provider Portal Support Specialist at 831-430-5518.
If you are missing information you previously had access to, such as certain providers, sites or missing reports, please contact the Provider Portal Representative at 831-430-5518.
Authorizations and Referrals
Yes. If your contact information is not already included in the dropdown box, you need to include contact information. This will allow Alliance staff to respond to your requests or call you with any questions.
Yes. When submitting referrals and/or authorizations, a sub-category is required in order to continue.
The member may not be linked to your office. The member’s PCP must submit all referrals. Please make sure your office checks eligibility prior to submitting referrals.
If the member is linked to your office but still isn't showing up, it may be that your permissions have changed. The member might be an Admin member due to being Newly Eligible. Once the member is assigned to your PCP office the portal will allow for the Referral submission request. Please call the Provider Portal Representative if you continue having issues regarding inputting the member 831-430-5518.
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Yes. These are all different ways to say “Alliance Member ID #” except for “Patient Account #" in the Claims Search function in the portal. The "Patient Account #" is an internal number assigned by the provider submitting the claim.
The claims re-submit option is only for some specialty claims. If the denied claim indicates the option at the bottom right of the portal page, then you are able to do a re-submit claim through the portal. If the option is not available for a denied claim through the portal, you may still re-submit a claim via paper form. You may also contact the Alliance Claims Department if you have questions on how they would like these claims to be submitted if not allowed via the portal at 831-430-5503.
Provider Change Requests
You will not be notified about your Provider Change Request directly. Please check back periodically via the Provider Portal to view the status of your request.
No, your office is not required to upload documents when submitting a PCR.
Reports/Records
This depends on the report you are accessing. The Alliance uses eCensus to capture ED and Inpatient visits. The Linked Member ED Visits and Linked Member Inpatient Admissions reports use eCensus data. Hospitals must participate and use eCensus in order for the Alliance to capture the data to post on the Provider Portal.
The Linked Member High ED Utilizer report pulls claims data rather than eCensus data. Because this report is matched to a claim, we are able to add the avoidable ED visit data.
The Alliance receives immunization data through claims data, immunization registries (CAIR/RIDE), and/or the Alliance’s Data Submission Tool. If you are seeing a member received their vaccine and it is not showing on the Provider Portal report it can mean:
- We did not receive the claim/appropriate billing code.
- The claim hasn’t been processed yet.
- Information is missing in your local immunization registry.
- Member name or date of birth doesn’t match what is in the immunization registry.
If you are seeing a discrepancy, clinics can still submit data using the Data Submission Tool or enter immunization information into the immunization registry (CAIR/RIDE). It is best practice to submit data monthly via the Data Submission Tool for monitoring ongoing improvement in Care-Based Incentive (CBI) performance.
For more information, please see the Immunizations: Children (Combo 10) and the Immunizations: Adolescents tip sheets on the Alliance’s website: https://thealliance.health/for-providers/manage-care/quality-of-care/care-based-incentive/care-based-incentive-resources/
The Alliance receives HbA1c screening dates via claims data. HbA1c lab values are only transmitted to the Alliance if a member uses a contracted laboratory, via claims or uploads to the Data Submission Tool. In order to ensure credit is given to your office, providers can upload a Comma Separated Value (CSV) file to the Data Submission Tool on the Provider Portal.
There are four options to extract data:
Option 1: Run a report from your Electronic Health Record system
Option 2: Run a report from your Point of Service HbA1c Analyzers
Option 3: Run a Diabetes Care quality report
Option 4: Manually compile patient data
Coding guidelines for HbA1c:
- CPT Codes: 83036, 83037
- LOINC Codes: 17856-6, 4548-4, 4549-2
- Telehealth Modifier Codes: GT, 95
- Telehealth Place of Service Code: 02 (for non-FQHCs)
CPT Category II codes are optional tracking codes that can be used for performance measurement, here defining the HbA1c range. They need to be submitted on the claim and may not be used as a substitute for Category I codes. CPT II codes are not accepted in the Data Submission Tool.
- 3044F - Most recent hemoglobin A1c (HbA1c) level less than 7.0% (DM)
- 3046F - Most recent hemoglobin A1c level greater than 9.0% (DM)
- 3051F- Most recent hemoglobin A1c (HbA1c) level greater than or equal to 7.0% and less than 8.0% (DM)
- 3052F- -Most recent hemoglobin A1c (HbA1c) level greater than or equal to 8.0% and less than or equal to 9.0% (DM)
When errors occur via the provider portal, the QI and Provider Relations team submit a ticket to the Technology team to notify of the issue and request repair. Some report errors can take longer to fix than others depending on the complexity of the issue. The Alliance will post a notification of all errors or delays on the provider portal home page to notify providers.
Providers are encouraged to contact their Provider Relations Representative at (800) 700-3874 ext. 5504 or the Provider Services Representative at (831) 430-5518.
Member ID’s will only by hyperlinked in the eligibility section of the provider portal when a member is linked to your practice. If a member’s linkage is to a clinic outside your organization, you will not be able to view the Member Report.
The Alliance has submitted a request for the creation of the new Well-Child and Adolescent Well-Care Visit report and it is currently in the queue. Due to competing priorities and limited staff the report creation has been delayed. We are hopeful it will be published soon.
We recommend checking the quality reports monthly. We recommend checking the reports after the 6th of the month. That gives the QI team time to review the reports to ensure they are functioning and pulling current information. If errors are identified this will be posted on the Provider Portal home page.
If you are reviewing the quality reports after submitting data via the Data Submission Tool, the time to check the reports is dependent on when you uploaded the information. If the upload was between the 1st and 24th of the month, your data will show on the next month’s report. If you submit your data after the 24th of the month it will show on the following months report.
Every evening at 6:00pm file submissions are processed through the Data Submission Tool to determine file status (acceptance/rejection rate). The QI team receives a copy of the file status for each submission. A member of the QI team will reach out to a clinic when noticing a trend in rejected files to assist in troubleshooting. If rejections continue to occur, please reach out to [email protected] for additional assistance with file submissions.
Yes, the best practice for submitting .csv files through the Data Submission Tool is to keep the column header row to avoid a rejected file. When column labels/headers are submitted, our system will still accept the file. When you log into to view your detailed report on the portal, you will see the column header row rejected. This will not affect your member specific data.
Training and Webinars
Yes. You can view the Provider Portal Webinar in the training section of our provider website. You can also request a copy of the webinar by contacting the Provider Portal Representative 831-430-5518.
Yes. Please contact the Provider Portal Representative at 831-430-5518 to schedule a presentation or contact your Provider Relations Representative at 831-430-5504.
Contact Provider Services
General | 831-430-5504 |
Cov Kev Thov 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 |
Lub Tsev Muag Tshuaj Authorizations, general pharmacy information or questions |
831-430-5507 |
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