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Phau Ntawv Rau Tus Kws Kho Mob

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New & Retired Alliance Provider Manual Policies

Policy Number	Title	Status	Approval Date
404-1702	Provision of Family Planning Services to Members	Approved	1/12/2023
300-4025	Provider Screening and Enrollment Guidelines	Approved	12/15/2022
105-3001	Program Integrity: Fraud, Waste & Abuse Prevention Program	Approved	12/9/2022
105-3001	Attachment A - Anti-FWA Laws and Regulations	Approved	12/9/2022
105-3002	Program Integrity: Special Investigations Unit Operations	Approved	12/9/2022
105-3002	Attachment A Anti-FWA Laws and Regulations	Approved	12/9/2022
105-3003	Suspended or Ineligible Providers	Approved	12/9/2022
105-3004	Verification of Billed Services by Network Providers	Approved	12/9/2022
404-1525	Skilled Nursing Program Policy for Medi-Cal	Approved	11/28/2022
404-1525	Attachment A - Skilled Nursing Facility Levels of Care Matrix	Approved	11/28/2022
404-1738	Community Health Worker Services	Approved	11/28/2022
404-1114	Continuity of Care	Approved	11/25/2022
404-1524	Long-Term Care for Medi-Cal Members	Approved	11/25/2022
403-1135	Compounded Drugs Requiring Special Handling	Retired	11/21/2022
403-1139	Opioid Utilization Review	Approved	11/21/2022
702-1300	Credit Balance Report	Approved	11/21/2022
702-1750	Coordination of Benefits Guidelines for Providers	Approved	11/21/2022
401-1505	Childhood Preventative Care	Approved	11/18/2022
401-1505	Attachment A - Childhood Preventative Care Bright Futures Form	Approved	11/18/2022
401-1505	Attachment B - CA Pediatric TB Risk Assessment	Approved	11/18/2022
401-1506	Immunization Services and Reimbursement	Approved	11/18/2022
401-1509	Kev Txais Kev Kho Mob Kom Raws Sijhawm	Approved	11/18/2022
401-1515	Nurse Midwife Scope of Practice and Supervision	Approved	11/18/2022
401-1523	NPMP Scope of Practice and Supervision	Approved	11/18/2022
404-1309	Member Access to Self Referred Services	Approved	11/18/2022
404-1527	Palliative Care	Approved	11/3/2022
404-1201	Authorization Request Process	Approved	10/26/2022
403-1149	Medical Nutrition Therapy	Approved	10/21/2022
300-4175	Enhanced Care Management Encounter Data	Approved	10/14/2022
300-4185	Community Supports Encounter Data	Approved	10/14/2022
300-4035	Community Health Workers Requirements	Approved	10/6/2022
300-4025	Provider Screening and Enrollment Guidelines	Approved	9/29/2022
404-1108	Monitoring of Over/Under Utilization of Services	Approved	9/28/2022
404-1112	Medical Necessity - The Definition and Application of Medical Necessity Provision to Authorization Requests	Approved	9/28/2022
404-1113	External Independent Medical Review	Approved	9/28/2022
404-1201	Authorization Request Process	Approved	9/28/2022
403-1141	Physician/Facility-Administered Drugs Requiring Prior Authorization	Approved	9/26/2022
404-1305	Screening and Referral of Medically Eligible Children to California Children's Services Program (CCS)	Approved	9/26/2022
404-1309	Member Access to Self Referred Services	Approved	9/26/2022
404-1314	Children with Special Health Care Needs (CSHCN)	Approved	9/26/2022
404-1530	Pediatric Complex Case Management	Approved	9/26/2022
404-1715	Genetic Testing	Approved	9/26/2022
404-1726	Non-Emergency Medical Transportation	Approved	9/26/2022
404-1732	Meals and Lodging ("Maintenance") and Related Expenses for Members	Approved	9/26/2022
403-1126	Pharmaceutical Services Access	Approved	9/2/2022
405-1305	Cov Kev Pab Cuam Kho Tus Cwj Pwm	Approved	9/1/2022
405-1312	Primary Care Provider Responsibilities Including Case Management and the Promotion of Patient Centered Medical Home	Approved	8/22/2022
405-1313	Adult Complex Case Management	Approved	8/22/2022
600-2201	Reimbursement for Non-Emergency Medical Transportation (NEMT) and Invoice Requirements	Approved	8/22/2022
300-4180	Training and Payment for Adverse Childhood Experiences	Approved	8/18/2022
300-8040	Monitoring PCP Capacity	Approved	8/17/2022
401-1501	Standards of Care	Approved	8/17/2022
600-1048	Manual Pricing of a Claim When There is No Medi-Cal Rate	Approved	8/8/2022
404-1713	Electromyography, Nerve Conduction Studies	Approved	7/7/2022
404-1101	Utilization Management Program	Approved	6/16/2022
404-1102	Inpatient Review	Approved	6/16/2022
404-1112	Medical Necessity - The Definition and Application of Medical Necessity Provision to Authorization Requests	Approved	6/16/2022

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