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Pending 2022 Annual Review

Xyoo 2021 Txoj Kev Npaj Thiab Cov Hom Phiaj Los Pab Cov Tswvcuab (Bridge Plan)

2021 PNA Report (Tri-county)

2022 PNA Report (Tri-county)

90-Day Referral Completion – Exploratory Measure Tip Sheet

A to Z Glossary of Spanish & Hmong Terms

Hais Txog Alliance

Adult Enhanced Care Management Provider Referral Form (age 21 and over)

Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents Tip Sheet

All Plan Letters

Alliance Cov Cai Rau Lwm Txoj Hauv Kev Mus Txais Tau Kev Pab Kho Mob (Alliance Alternative Access Standards)

Alliance Care IHSS Daim Ntawv Qhia Txog Cov Kev Kho Mob Uas Pab Them Rau

Alliance Kev Saib Xyuas IHSS Phau Ntawv Rau Tus Tswvcuab

Tus Nqi Pob Tshab Ntawm Alliance Kev Saib Xyuas IHSS

Alliance Care IHSS Daim Ntawv Qhia Txog Cov Kev Pab Kho Mob Uas Txais Tau thiab Cov Kev Fajseeb Kho Mob

Alliance Care Cov Kev Pab Tu Neeg Hauv Tsev (In-Home Supportive Services; IHSS, raws li sau hauv lus Askiv)

Alliance Holidays

Alliance Cov Kev Pab Cuam Txhais Lus

Allied Health Professional Credentialing Application

Kuv Puas Tsim Nyog Tau Txais?

Kuv Puas Tsim Nyog Tau Txais?

Ambulatory Care Sensitive Admissions Tip Sheet

Antidepressant Medication Management Tip Sheet

Application of Fluoride Varnish Tip Sheet

Cov Kev Pom Zoo rau Kev Kho Mob

Kev Mob Hawb Pob

Asthma Education Benefit Description

Asthma Education is Available for Your Alliance Patients

Asthma Medication Ratio Tip Sheet

Asthma Self-Management Education Checklist

Authorization Status Request

Beacon Health Options Medi-Cal Provider FAQs

Beacon Health Options Screening Guidelines for Autism

Cov Kev Pab Kho Mob Uas Txais Tau

Cov Kev Pab Kho Mob Uas Txais Tau

Best Practices for Reducing Patient No-Shows Tip Sheet

Blood Lead Testing Flyer

Breast Cancer Screening Tip Sheet

Kev Pub Niam Mis

Breastfeeding and Lactation Education Checklist

Kev Pab Txhawb Me Nyuam Noj Mis thiab Cov Nyiaj Pab Taub Mis

Breastfeeding Support and Breast Pump Benefit Clinical Health Education Benefit

California Advance Health Care Directive Form

California Participating Practitioner Application

Capital Program

Kev Pab Cuam Tswj Kev Tu Xyuas

Care-Based Incentive

Care-Based Incentive (CBI) Summary

Carelon Care Management Referral Form

Carelon Diagnostic Evaluation Form (Medi-Cal)

Carelon Primary Care Provider (PCP) Referral Form

Case Management Referral Form

CBI Technical Specifications

Central California Alliance for Health

Certification Regarding Debarment Suspension, Ineligibility and Voluntary Exclusion

Certification Regarding Lobbying – Exhibit D(F) Att 1 and 2

Cervical Cancer Screening Tip Sheet

Cov Kev Hloov rau Qhov Kev Pab Cuam Rau Pej Xeem Uas Tau Npav Ntsuab Ntawm Tsoom Fwv (Public Charge)

Cov kev tuaj kuaj kuj

Child and Adolescent Well-Care Visits Tip Sheet

Child and Adolescents BMI Assessment Tip Sheet

Chlamydia Screening in Women – Exploratory Measure Tip Sheet

Xaiv Koj Tus Kws Kho mob

Cov Kev Mob Mus Ntev

CHW Recruitment Program

Cov Kev Pab Kho Mob

Colorectal Cancer Screening – Exploratory Measure Tip Sheet

Community Based Adult Services (CBAS) Inquiry Form

Cov Koom Txoos Hauv Zej Zog

Community Health Champions

Cov Ntaub Ntawv Qhia Tias Tau Pab Zej Zog Npaum Li Cas (Community Impact Reports)

Zej Zog Cov Ntaub Ntawv Tshaj Tawm

Cov Kev Pab Rau Neeg Zej Zog

Cov Zej Zog Kev Pab Txhawb

Community Supports (CS) Provider Information

Community Supports: Environmental Accessibility and Adaptability (EAA) Provider Referral Form

Community Supports: Housing Provider Referral Form

Community Supports: Meals Provider Referral Form

Community Supports: Personal Care and Home Maker Services and Respite Services for Caregivers Provider Referral

Complex Case Management and Care Coordination

Daim Foos Thov Kom Xa Cov Ntawv Txwv Tsis Pub Lwm Tus Paub Rau Lwm Txoj Kev Sib Txuas Lus

Consent for Sterilization or Hysterectomy Sample Form

Tiv Toj Rau Peb

Controlling High Blood Pressure – Exploratory Measure Tip Sheet

Corrected Claim Submission Form

Ntaub ntawv rau kab mob COVID-19

Kev Kuaj thiab Kho Tus Kab Mob COVID-19

COVID-19 Vaccine Administration for Providers

Cov Xov Xwm Txog Cov Koob Tshuaj Tiv Thaiv Tus Kab Mob COVID-19

Lus Qhia Txog Koob Txhaj Tshuaj Tiv Thaiv Kab Mob COVID-19 rau Cov Tswvcuab Medi-Cal

Lus Qhia Txog Koob Tshuaj Txhaj Tiv Thaiv Kab Mob Rau Medi-Cal Cov Tswvcuab Daim ntawv qhia

COVID-19 Vaccine Information Videos

COVID-19: Information for Providers

Credit Balance Report

Xaus nrog COVID!

Cov Kev Pab Cuam Fab Kab Lis Kev Cai thiab Lus Hais

Kev Kho Hniav thiab Kuaj Qhov Muag

Depression Tool Kit

Developer Application

Developer Questionnaire

Developer Resources

Developmental Screening in the First 3 Years Tip Sheet

DHCS Facility Site Review (FSR) Checklist

DHCS Medical Record Review (MRR) Checklist

DHCS Vaccine Recommendations During COVID-19

Diabetes Eye Exam Services Resource List – English

Diabetes Eye Exam Services Resource List – Hmong

Diabetes Eye Exam Services Resource List – Spanish

Diabetes Self-Management Education Benefit Description

Kev Mob Ntshav Qab Zib/Kev Pib Mob Ntshav Qab Zib

Diabetic HbA1c Poor Control >9% Tip Sheet

Disease Management Programs

Doula Provider Application

Durable Medical Equipment Provider Application

EDI Claims Enrollment Form

EDI Claims Enrollment Form Instructions

EDI Companion Guide – 270/271 Information

EDI Companion Guide – 276/277 Information

EDI Companion Guide – 837/835 Trading Partner Information

EDI Companion Guide – Transaction Instruction

Kev Txhim Kho Kev Pab Tswj Kev Tu Xyuas (Enhanced Care Managment; ECM raws li sau hauv lus Askiv)

Enhanced Care Management (ECM) and Community Supports Provider Information

Enhanced Care Management (ECM) and Community Supports Provider Referrals

Enhanced Care Management (ECM) and Community Supports Trainings

Enhanced Care Management (ECM) Provider Information

Enhanced Care Management and Community Supports for Members

Equity Learning for Health Professionals Program

Face-to-Face Interpreter Request Form

Facility Site Review

Daim Ntawv Qhia Txog Qhov Tsheeb

Kev Npaj Rau Tsev Neeg

Rau Cov Zej Zog

Rau Cov Tswvcuab

Rau Cov Kws Kho Mob

FSR and MRR Update Attestation

FSR Critical Elements: Interim Monitoring Form

Cov Xov Xwm Txog Tus Kab Mob COVID-19

Mus Txais Kev Kho Mob

Cov Ntsiab Lus Txhais

Grants at Work

Daim Ntawv Ua Hais Kev Tsis Txaus Siab

Grievance Form In-Home Supportive Services (IHSS)

Daim Ntawv Ua Hais Kev Tsis Txaus Siab Rau Medi-Cal

Kev Nyob Noj Qab Haus Huv thiab Noj Qab Nyob Zoo

Kev Qhia Txog Kev Noj Qab Haus Huv thiab Kev Tswj Hwm Kab Mob

Health Education Programs

Cov Kev Npaj Kho Mob

Health Programs Referral Form

Health Resources

Txoj Kev Pab Cuam Txiaj Ntsig Pab Rau Kev Noj Qab Haus Huv

Healthcare Technology Program

Healthy Breathing for Life Asthma Management Program

Neeg zej zog muaj kev noj qab haus huv

Cov Leej Niam, Cov Menyuam Mosliab Muaj Kev Noj Qab Haus Huv

Kev Pib Noj Qab Haus Huv

Txoj Kev Pab Cuam Cia Lub Cev Hnyav Kom Haum Yuav Pab Tau Muaj Kev Noj Qab Nyob Zoo Mus Tag Tiam

HEDIS Code Set

HEDIS FAQ Guide

HEDIS Resources

Home Visiting Program

How to Apply

Yuav Koom Tau Li Cas

Yuav Koom Tau Li Cas

Yuav Koom Tau Li Cas

Immunization Resources

Cov Sijhawm Mus Txhaj Tiv Thaiv Kab Mob thiab Cov Koob Txhaj Tshuaj Tiv Thaiv Kab Mob

Immunizations: Adolescents Tip Sheet

Immunizations: Adult – Exploratory Measure Tip Sheet

Immunizations: Children (Combo 10) Tip Sheet

Infection Control: Spore Testing Job Aid

Kev Nthuav Tawm Ntaub Ntawv

Initial Health Assessment

Initial Health Assessment Tip Sheet

Cov lus qhia txog yuav ua li cas thiaj rub tawm tau ib daim ntawv foos 

Cov Lus Qhia Txog Kev Fajseeb Kho Mob

International Board Certified Lactation Consultants and Breast Pump Vendor List

Interpreter Services Provider Quick Reference Guide

Interpreter Services Quality Assurance Form

Cov Lus Qhia Txog Qhov Kev Pab Cuam Medi-Cal Rx

job

Koom Nyob Hauv Peb Pab Pawg Koom Tes

Lead Screening in Children – Exploratory Measure Tip Sheet

Cov Thawj Coj

Linguistic Competence Provider Incentive

Linguistic Competence Provider Incentive Attestation

Locum Tenens Notification Form

Long Term Care Treatment Authorization Request

MA Recruitment Program

Kev Pab Tswj Kho Mob

Kev Tswj Tus Kab Mob

Maternity Care: Postpartum Tip Sheet

Maternity Care: Prenatal Tip Sheet

Maximizing Routine Immunization During the COVID-19 Pandemic

Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet

Medi-Cal

Daim Qhia Txog Cov Kev Kho Mob Uas Pab Them Rau

Medi-Cal Phau Ntawv Qhia Siv Rau Tswv Cuab

Medi-Cal Provider-Preventable Conditions Reporting Portal

Medi-Cal Rx

Medical Clearance for General Anesthesia or IV Sedation for Dental Procedures

Khoom Siv Kho Mob

Medical Nutrition Therapy Benefit Quick Reference Guide

Medical Record Review

Medication Management Agreement (MMA)

Member Grievance Form – IHSS

Member Grievance Form – Medi-Cal

Npav ID Tswvcuab

Cov Kev Txhawb Zog Rau Tus Tswvcuab

Tswvcuab Cov Xov Xwm

Member Notice Letters

Cov Tswv Cuab lub online account

Daim Foos Thov Them Nyiaj Rov Qab Rau Tswvcuab

Lub Chaw Pab Cuam Tswvcuab

Daim Ntawv Thov Pab Pawg Pab Tswv Yim Rau Cov Kev Pab Cuam Tswv Cuab

Lub Zeem Muag, Lub Luag Haujlwm thiab Cov Kev Tseem Ceeb

New Non-PCP Training

New PCP Training

New Provider Attestation Form

New Provider ECM/Community Supports Training Sign Off Form

Txoj Kev Muab Kev Kawm Qhia Rau Cov Kws Pab Kho Mob Tshiab

Cov Xov Xwm

Non-Physician Medical Practitioner Application

Txoj Cai Rau Kev Tsis Cais Kev Npaj Kho Mob

Daim Ntawv Ceeb Toom Txog Kev Txwv Tsis Pub Lwm Tus Paub Txog

Kws Tu Mob Tus Xov Tooj Muab Lus Qhia

Online Provider Directory Tutorial

Kev Pab Cuam Saum Ooslais (Online)

Thov Rau Ib Daim Npav ID, Ib Phau Ntawv Rau Tus Tswvcuab thiab Ib Phau Ntawv Teev Npe Cov Kws Kho Mob

Organizational Provider Application

Other Health Coverage (OHC) Referral Form

Lwm Cov Kev Pab Cuam

Our Test Page

Outpatient Clinical Laboratory Provider Application

Pain Management and Substance Use Resources

Parent Education and Support Program

Partners for Active Living Program

Partners for Healthy Food Access Program

Pass Through/Supplemental Payments FAQ

Patient Complaint/Grievance Tracking Log

Pharmacy Forms

Pharmacy Services

Physical Accessibility Review Survey

Physician Certification Statement of Medical Necessity for NEMT

Physician Orders for Life-Sustaining Treatment (POLST)

Plan All-Cause Readmissions Tip Sheet

Cov Nqi Uas Yuav Tau Them

Cov Tshuaj Raws Daim Ntawv Xaj Yuav Tshuaj thiab Cov Kev Txais Tau Tshuaj

Preventable Emergency Care Visit Diagnosis Tip Sheet

Preventable Emergency Visits Tip Sheet

Prevention and Self-Management Programs

Thawj Qhov Kev Kho Mob

Prior Authorization Criteria

Prior Authorization Information Request for Injectable Drugs

Cov Lus Thov Txwv Tsis Pub Lwm Tus Paub

Procedure Reimbursement Rate Request

Programmatic Measure Benchmarks & Performance Improvement

Provider Change Request (PCR)

Provider Compliance Concern Report

Provider Credentialing Applications and Policies

Provider Directory Information Attestation Form

Provider Event Submission

Provider Events Calendar

Provider Identified Overpayment Form

Provider Information Change Form

Provider Inquiry Form

Phau Ntawv Rau Tus Kws Kho Mob

Provider Network Interest Form

Cov Xov Xwm Qhia Rau Kws Kho Mob

Provider News Archives

Provider News Posts

Kws Kho Mob Lub Chaw Tswj Xyuas Tswvcuab Cov Ntaub Ntawv

Provider Portal Account Request Form – Step 2

Provider Recruitment Program

Provider Resources

Cov Rooj Sib Tham Qhib Rau Pej Xeem

Kev Mus Ntsib tus Kws Kho Mob

Re-Credentialing

Cov ntaub ntawv tswj hwm

Remittance Advice Explain Codes

Remittance Advice Guide

Request for Member Reassignment Form

Request for Provider Information

Kev Thov Rau Tus Neeg Sawv Cev Rau Koj

Screening for Depression and Follow-Up Plan Tip Sheet

Seniors and Disabilities

Social Media Code of Conduct

Lub Khws muag tshuaj SortPak

Nyob ib kauj ruam ua ntej kom tsis txhob kis tau tus kab mob COVID-19

Nyob Nrog Txoj Kev Noj Qab Nyob Zoo

Staying Healthy Assessment

Kev Npaj Tswv Yim Ua Tiav Xyoo 2022-2026

Synagis Statement of Medical Necessity

Kev Sib tham Hauv Vis Dis Aus (Video) lossis Hu Xov Tooj Nrog Kws Kho Mob (Telehealth)

Tobacco Cessation Benefit Description

Transparency in Coverage (CMS 9915) Machine Readable Files

Transportation Provider Application

Transportation Services Request Form

Treatment Authorization Request (TAR)

Tuberculosis (TB) Risk Assessment – Exploratory Measure Tip Sheet

Unhealthy Alcohol Screening and Behavioral Counseling

Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet