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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
600-2201	Reimbursement for Non-Emergency Medical Transportation (NEMT) and Invoice Requirements	Approved	7/13/2023
405-1308	Enhanced Care Management Overview	Approved	6/27/2023
600-1007	Durable Medical Equipment Rent-to-Purchase Pricing	Approved	6/27/2023
300-3090	Attachment B - Quarterly Timeline	Approved	6/22/2023
300-3090	Attachment A - Provider Manual Update Flow Chart	Approved	6/22/2023
300-4045	Doula Requirements	Approved	6/21/2023
600-1009	Corrected Claim Submissions	Approved	6/14/2023
404-1113	External Independent Medical Review	Approved	6/12/2023
401-1201	Quality Improvement Health Equity Committee	Approved	4/24/2023
401-1501	Standards of Care	Approved	4/24/2023
401-1502	Adult Preventive Care	Approved	4/24/2023
401-1505	Childhood Preventive Care	Approved	4/24/2023
401-1505	Attachment A - AAP Recommendations for Preventive Pediatric Health Care	Approved	4/24/2023
401-1505	Attachment B - CA Pediatric TB Risk Assessment	Approved	4/24/2023
401-1511	Initial Health Appointment	Approved	4/24/2023
401-1519	Infection Control Practices	Approved	4/24/2023
404-1102	Inpatient Review	Approved	4/21/2023
404-1109	Disclosure of Utilization Management Process to Providers, Members and the Public	Approved	4/21/2023
404-1112	Medical Necessity - The Definition and Application of Medical Necessity Provision to Authorization Requests	Approved	4/21/2023
404-1201	Authorization Request Process	Approved	4/21/2023
405-1304	Developmental Disabilities - Services to Plan Members	Approved	4/21/2023
405-1312	Primary Care Provider Responsibilities Including Case Management and the Promotion of Patient Centered Medical Home	Approved	4/21/2023
405-1315	Children with Special Health Care Needs (CSHCN)	Approved	4/21/2023
405-1317	Early Intervention Services	Approved	4/21/2023
405-1318	Pediatric Complex Case Management	Approved	4/21/2023
408-1305	Cov Kev Pab Cuam Kho Tus Cwj Pwm	Approved	4/21/2023
600-1050	Implementation of Medi-Cal Rates	Approved	4/13/2023
404-1114	Continuity of Care	Approved	4/11/2023
404-1715	Genetic Testing	Approved	4/11/2023
404-1727	Provision of Telehealth Services to Alliance Members	Approved	4/11/2023
405-1108	Medi-Cal Home and Community Based Services (HCBS) Waiver Programs	Approved	4/11/2023
403-1103	Pharmacy Authorization Request Review Process	Approved	4/4/2023
403-1146	Drug Waste Reimbursement	Approved	4/4/2023
405-1314	Transitional Care Services	Approved	3/23/2023
300-4046	Street Medicine Providers	Approved	3/11/2023
300-4195	Provider Training and Payment for Annual Cognitive Health Assessments	Approved	3/11/2023
404-1707	Acupuncture Services for Medi-Cal Members	Approved	3/11/2023
300-4045	Doula Requirements	Approved	3/7/2023
404-1101	Utilization Management Program	Approved	3/7/2023
404-1108	Monitoring of Over/Under Utilization of Services	Approved	3/7/2023
404-1202	After-Hours Availability of Plan or Contract Physician	Approved	3/7/2023
404-1303	Referral Consultation Request Process	Approved	3/7/2023
404-1306	Extended and Standing Referral Authorizations	Approved	3/7/2023
404-1309	Member Access to Self Referred Services	Approved	3/7/2023
404-1310	Authorization Process for Referrals to Out of Area and Non-Contracted Specialty Providers	Approved	3/7/2023
404-1524	Long-Term Care for Medi-Cal Members	Approved	3/7/2023
404-1702	Provision of Family Planning Services to Members	Approved	3/7/2023
404-1724	Hospital Transportation from PCP Office	Approved	3/7/2023
404-1731	Medication Assisted Treatment	Approved	3/7/2023
404-1738	Community Health Worker Services	Approved	3/7/2023
401-1301	Potential Quality Issue Review Process	Approved	2/16/2023
401-1705	Care-Based Incentive Program	Approved	2/16/2023
401-4103	Interpreter Services	Approved	2/16/2023
300-4035	Community Health Workers Requirements	Approved	1/31/2023
300-9010	Review Procedure for Decisions Concerning Provider Network Participation	Approved	1/31/2023
404-1310	Attachment A - Requirements for Referral of Members to Specialty Providers	Approved	1/31/2023
405-1313	Adult Complex Case Management	Approved	1/31/2023
405-1111	Community Based Adult Services	Approved	1/19/2023
300-4190	Electronic Visit Verification	Approved	1/18/2023
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

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