Notification of change: Claim adjudication for TotalCare members
When submitting claims for TotalCare (HMO D-SNP) members, providers must bill using the TotalCare member ID number rather than the Medi-Cal member ID number.
Previously, as a courtesy, claims that were mistakenly submitted with a Medi-Cal ID were adjusted to process under the TotalCare ID. Effective April 1, 2026, this practice will be discontinued. Claims submitted for TotalCare members using a Medi-Cal ID will be denied.
To avoid delays or denials, please ensure that all future claims are submitted with the correct TotalCare ID.
If you have questions regarding this change, please contact Claims Customer Service at 831-430-5503, Option 3. For more information on TotalCare billing, please visit our Cov nplooj ntawv thov kev pab.
Behavioral health transitions of care: tools and best practices
Are you serving members that need additional or different levels of behavioral health care services, intensive outpatient services or substance use disorder treatment? Depending on a member’s evolving needs, they may require behavioral health care services from the Alliance or the county.
The Transition of Care Tool for Medi-Cal Mental Health Services (TOC Tool) is a standardized instrument provided by the California Department of Health Care Services (DHCS). It can be used by both the county and Alliance providers to refer members between behavioral health care services and is designed to support timely and coordinated care.
To ensure the best care for members, it is essential to understand how to use this tool in your practice.
How to use the TOC Tool
- Sau cov TOC Tool.
- If you are requesting a higher level of care (HLOC) or treatment for substance use: submit the completed tool to the member’s county behavioral health department. Please note that it is the provider, not the Alliance, who is responsible for completing the HLOC request and including the necessary clinical information.
- If a county provider is requesting stepping down to non-specialty mental health services (NSMHS), they submit the completed tool to the Alliance via email.
Cov kev coj ua zoo tshaj plaws
- Initiate shared decision making with the member.
- Gather key clinical information.
- Submit to the appropriate system (the Alliance or the county).
- Maintain documentation.
- Monitor the referral.
Cov lus nug?
If you need further support, please call 800-700-3874 and ask to speak to the Behavioral Health team.
We appreciate your partnership in helping our members get the right care at the right time!
Cov peev txheej ntxiv
- Alliance provider behavioral health webpage.
- DHCS additional screening and TOC tools.
- DHCS FAQs: Screening and TOC Tools for Medi-Cal Mental Health Services.
Review the All Plan Letter (APL) and legislative updates
The California Department of Managed Health Care (DMHC) has updated multiple All Plan Letters (APL). These changes are important to know, as they may impact how you provide services.
Yog xav paub ntxiv txog APLs tshiab thiab lwm yam, koj tuaj yeem mus ntsib peb Txhua Daim Ntawv Npaj Cov Ntawv Webpage. Koj tseem tuaj yeem nrhiav Alliance cov cai thiab cov txheej txheem cuam tshuam hauv Alliance Provider Phau Ntawv Qhia.
Please see below for the legislative updates.
AB 260 – Sexual and Reproductive Health Care
- Protects access to sexual and reproductive health care in California. AB 260 strengthens California law to ensure patients can continue to access reproductive health services, including medication abortion. It protects health care providers, pharmacies and related entities when they provide care that is legal in California.
- Expands safe and private care options for patients. The law supports the use of telehealth for reproductive health services and allows certain privacy protections, helping patients receive care confidentially and without unnecessary barriers.
AB 1037 – Public Health: Substance Use Disorder (SUD)
- Expands access to life-saving substance use disorder supports. Assembly Bill 1037 strengthens public health efforts by increasing access to overdose prevention tools like naloxone, supporting harm reduction services, and ensuring individuals can receive help without unnecessary barriers such as mandatory sobriety to enter or stay in treatment.
- Promotes safer, evidence-based care for individuals and communities. The law encourages treatment approaches that focus on engagement, safety and long-term recovery while providing legal protections for good-faith efforts to prevent overdoses and reduce the spread of infectious diseases.
SB 497 – Legally Protected Health Care Activity
- The bill protects patients and health care providers in California by limiting the disclosure of medical information related to legally protected health care services. California entities are not required to cooperate with out-of-state legal actions that seek to penalize individuals or providers for care that is lawful in California.
- The law strengthens privacy and safety safeguards by restricting the release of health records and related data when requests are tied to laws from other states that conflict with California’s protections. SB 497 still allows disclosures required under California or federal law.
SB 439 – California Health Benefit Review Program (CHBRP): Extension
- It extends the California Health Benefit Review Program (CHBRP) through 2033, allowing the program to continue providing independent analyses of proposed health insurance benefit legislation, including potential public health, medical and cost impacts.
- The bill does not change current health benefits or provider requirements, but supports informed decision-making by lawmakers when considering future health coverage proposals that may affect Californians, including those enrolled in Medi-Cal.
- This bill updates and clarifies California health laws by making technical improvements to existing requirements, including how certain health facilities submit patient safety plans, how some workforce training standards are defined, and how hospitals may provide charity care and discount payment notices to patients.
- The bill does not change covered benefits or eligibility for Medi-Cal, Medicare, or other health programs, but helps modernize and streamline health care processes to support patient safety, transparency, and clearer communication between health care providers and patients.
