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Pending Department Review

Kev Kuaj thiab Kho Tus Kab Mob COVID-19

September 25, 2023
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Cov Xov Xwm Txog Tus Kab Mob COVID-19

September 25, 2023
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Cov Xov Xwm Txog Cov Koob Tshuaj Tiv Thaiv Tus Kab Mob COVID-19

September 25, 2023
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Carelon Primary Care Provider (PCP) Referral Form

September 19, 2023
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Community Supports (CS) Provider Information

August 23, 2023
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Enhanced Care Management (ECM) Provider Information

August 23, 2023
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Enhanced Care Management (ECM) and Community Supports Provider Referrals

August 23, 2023
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Enhanced Care Management and Community Supports for Members

August 18, 2023
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Enhanced Care Management (ECM) and Community Supports Provider Information

August 15, 2023
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Grants at Work

August 11, 2023
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Enhanced Care Management (ECM) and Community Supports Trainings

August 11, 2023
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Doula Provider Application

August 3, 2023
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Cov Kev Pab Uas Txais Tau ntawm Kev Pab Cuam Txog Kev Yug Menyuam

August 3, 2023
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Cov Kev Pab Txhawb Hauv Zej Zog: Cov Kev Pab Cuam Tu Neeg Thiab Tu Tsev thiab Kev Pab Cuam Rau Kev So Ib Vuag rau Cov Neeg Saib Xyuas txog ntawm Kev Xa Mus Rau Kws Kho Mob Pab Saib Xyuas

July 7, 2023
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Daim Foos Hais Txog Kev Xa Mus Rau Kws Kho Mob Rau Cov Hluas Ntawm Pab Pawg Kev Txhim Khu Kev Pab Tswj Kev Tu Xyuas (20 xyoos thiab yau dua)

July 7, 2023
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Community Supports: Personal Care and Home Maker Services and Respite Services for Caregivers Provider Referral

July 7, 2023
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Youth Enhanced Care Management Provider Referral Form (age 20 and under)

July 7, 2023
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Cov Kev Pab Kho Mob Uas Txais Tau Ntawm Tus Neeg Tuav Ntaub Ntawv rau Kev Noj Qab Haus Huv Hauv Zej Zog

June 23, 2023
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Provider Network Interest Form

June 14, 2023
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All Plan Letters

May 24, 2023
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Parent Education and Support Program

May 12, 2023
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Community Health Champions

May 12, 2023
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Equity Learning for Health Professionals Program

May 12, 2023
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Linguistic Competence Provider Incentive

May 12, 2023
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Workforce Recruitment Programs

May 12, 2023
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MA Recruitment Program

May 12, 2023
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Provider Information Change Form

April 19, 2023
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Healthcare Technology Program

April 7, 2023
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Home Visiting Program

April 7, 2023
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Partners for Active Living Program

April 7, 2023
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CHW Recruitment Program

April 7, 2023
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Tswvcuab Cov Xov Xwm

March 28, 2023
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Re-Credentialing

March 23, 2023
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Daim Foos Kev Xa Mus Rau Cov Tswvcuab Ntawm Pab Pawg Kws Tswj Kev Tu Xyuas Uas Muaj Kev Txhim Kho Rau Cov Neeg Laus (21 xyoos thiab tshaj ntawd)

March 13, 2023
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Zej Zog Kev Pab Txhawb: Daim Ntawv Foos Xa Mus Txais Zaub Mov Noj Rau Tswvcuab

March 13, 2023
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Zej Zog Kev Pab Txhawb: Daim Ntawv Foos Xa Mus Txais Kev Pab Vaj Tsev Nyob Rau Tswvcuab

March 13, 2023
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Zej Zog Kev Pab Txhawb: Daim Ntawv Foos Xa Mus Xyuas Seb Puas Muaj Feem thiab Nyob Tau Tom Tsev (Environmental Accessibility and Adaptability; EAA, raws li sau hauv lus Askiv) Rau Tswvcuab

March 13, 2023
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Txoj Kev Pab Cuam Txiaj Ntsig Pab Rau Kev Noj Qab Haus Huv

March 10, 2023
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Kev Pib Noj Qab Haus Huv

March 3, 2023
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Medi-Cal Renewal

March 1, 2023
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Linguistic Competence Provider Incentive Attestation

January 23, 2023
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Qhia dua tshiab txog koj qhov Medi-Cal

January 4, 2023
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Kev Saib Xyuas Kev Kho Mob Uas Muaj Kev Txhim Kho Lawm thiab Kev Txhawb Nqa Zej Zog 

December 27, 2022
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Community Supports: Environmental Accessibility and Adaptability (EAA) Provider Referral Form

December 22, 2022
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Community Supports: Meals Provider Referral Form

December 22, 2022
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Cov Zej Zog Kev Pab Txhawb

December 15, 2022
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Kev Txhim Kho Kev Pab Tswj Kev Tu Xyuas (Enhanced Care Managment; ECM raws li sau hauv lus Askiv)

December 15, 2022
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Colorectal Cancer Screening – Exploratory Measure Tip Sheet

December 14, 2022
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EDI Claims Enrollment Form Online

December 8, 2022
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Tus Nqi Pob Tshab Ntawm Alliance Kev Saib Xyuas IHSS

December 5, 2022
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Cov Kev Hloov rau Qhov Kev Pab Cuam Rau Pej Xeem Uas Tau Npav Ntsuab Ntawm Tsoom Fwv (Public Charge)

November 22, 2022
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Request for Provider Information

November 21, 2022
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Grievance Form In-Home Supportive Services (IHSS)

November 16, 2022
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Daim Ntawv Ua Hais Kev Tsis Txaus Siab Rau Medi-Cal

November 16, 2022
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Provider Portal Account Request Form – Step 2

November 3, 2022
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Cov Koom Txoos Hauv Zej Zog

September 28, 2022
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Pharmacy Forms

September 6, 2022
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Locum Tenens Notification Form

August 18, 2022
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Webinars Archive List

August 9, 2022
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Kev Mus Ntsib tus Kws Kho Mob

August 9, 2022
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Qhov Kev Pab Cuam Wellness that Works

August 9, 2022
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Txoj Kev Pab Cuam Cia Lub Cev Hnyav Kom Haum Yuav Pab Tau Muaj Kev Noj Qab Nyob Zoo Mus Tag Tiam

August 9, 2022
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Cov Leej Niam, Cov Menyuam Mosliab Muaj Kev Noj Qab Haus Huv

August 9, 2022
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Kev Pub Niam Mis

August 9, 2022
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Cov Kev Mob Mus Ntev

August 9, 2022
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Kev Mob Ntshav Qab Zib/Kev Pib Mob Ntshav Qab Zib

August 9, 2022
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Kev Mob Hawb Pob

August 9, 2022
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Cov kev tuaj kuaj kuj

August 9, 2022
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Cov Sijhawm Mus Txhaj Tiv Thaiv Kab Mob thiab Cov Koob Txhaj Tshuaj Tiv Thaiv Kab Mob

August 9, 2022
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Kev Nyob Noj Qab Haus Huv thiab Noj Qab Nyob Zoo

August 8, 2022
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Provider News Posts

July 19, 2022
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Our Test Page

July 12, 2022
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2022 PNA Report (Tri-county)

July 11, 2022
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Daim Foos Thov Kom Xa Cov Ntawv Txwv Tsis Pub Lwm Tus Paub Rau Lwm Txoj Kev Sib Txuas Lus

June 22, 2022
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Provider Event Submission

May 4, 2022
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FSR and MRR Update Attestation

April 14, 2022
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Provider Events Calendar

April 6, 2022
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Provider Compliance Concern Report

March 29, 2022
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Provider News Archives

March 29, 2022
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Nyob ib kauj ruam ua ntej kom tsis txhob kis tau tus kab mob COVID-19

March 21, 2022
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Cov lus qhia txog yuav ua li cas thiaj rub tawm tau ib daim ntawv foos 

March 4, 2022
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Zej Zog Cov Ntaub Ntawv Tshaj Tawm

February 24, 2022
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2021 PNA Report (Tri-county)

February 16, 2022
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Cov Ntaub Ntawv Qhia Tias Tau Pab Zej Zog Npaum Li Cas (Community Impact Reports)

February 16, 2022
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Member Grievance Form – IHSS

February 3, 2022
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Member Grievance Form – Medi-Cal

February 3, 2022
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Adult Enhanced Care Management Provider Referral Form (age 21 and over)

January 4, 2022
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Community Supports: Housing Provider Referral Form

January 4, 2022
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Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents Tip Sheet

Lub Ib Hli Ntuj Hnub Tim 1, 2022
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Screening for Depression and Follow-Up Plan Tip Sheet

Lub Ib Hli Ntuj Hnub Tim 1, 2022
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Cov Tswv Cuab lub online account

December 29, 2021
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New Provider ECM/Community Supports Training Sign Off Form

December 14, 2021
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Xaus nrog COVID!

October 7, 2021
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Procedure Code Lookup Tool

October 5, 2021
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Cov Lus Qhia Txog Qhov Kev Pab Cuam Medi-Cal Rx

August 17, 2021
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Lub vev xaib cov lus taw qhia

August 10, 2021
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Medi-Cal Rx

August 9, 2021
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Daim Ntawv Ceeb Toom Txog Kev Txwv Tsis Pub Lwm Tus Paub Txog

July 28, 2021
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New Provider Attestation Form

July 6, 2021
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Provider Approval Checklist Diabetes Prevention & Self Management Education

June 29, 2021
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Asthma Education is Available for Your Alliance Patients

June 26, 2021
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Prevention and Self-Management Programs

June 26, 2021
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2020 PNA report (tri-county)

June 25, 2021
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Diabetes Eye Exam Services Resource List – Hmong

June 25, 2021
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Diabetes Eye Exam Services Resource List – Spanish

June 25, 2021
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Diabetes Eye Exam Services Resource List – English

June 25, 2021
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COVID-19 Vaccine Information Videos

June 22, 2021
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COVID-19: Information for Providers

June 18, 2021
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Online Provider Directory Tutorial

June 18, 2021
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PCP MAT in the Provider Portal

June 15, 2021
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Asthma Education Benefit Description

June 14, 2021
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Carelon Care Management Referral Form

June 13, 2021
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Carelon Diagnostic Evaluation Form (Medi-Cal)

June 13, 2021
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PCP Decision Support Services

June 11, 2021
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Maximizing Routine Immunization During the COVID-19 Pandemic

June 4, 2021
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New Non-PCP Training

June 3, 2021
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New PCP Training

June 3, 2021
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Beacon Health Options Screening Guidelines for Autism

June 1, 2021
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Beacon Health Options Medi-Cal Provider FAQs

June 1, 2021
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Kev Pab Txhawb Me Nyuam Noj Mis thiab Cov Nyiaj Pab Taub Mis

June 1, 2021
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Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet

June 1, 2021
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Health Resources

June 1, 2021
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Seniors and Disabilities

June 1, 2021
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Pain Management and Substance Use Resources

June 1, 2021
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Complex Case Management and Care Coordination

June 1, 2021
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Diabetes Prevention Program (DPP) Benefit Description

May 31, 2021
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Tobacco Cessation Benefit Description

May 31, 2021
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International Board Certified Lactation Consultants and Breast Pump Vendor List

May 31, 2021
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Breastfeeding Support and Breast Pump Benefit Clinical Health Education Benefit

May 31, 2021
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Healthy Breathing for Life Asthma Management Program

May 31, 2021
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Clinical Health Education Benefits Provider Application

May 31, 2021
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Breastfeeding and Lactation Education Checklist

May 29, 2021
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Asthma Self-Management Education Checklist

May 29, 2021
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Diabetes Self-Management Education Benefit Description

May 29, 2021
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Health Programs Referral Form

May 29, 2021
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Disease Management Programs

May 29, 2021
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Health Education Programs

May 29, 2021
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Member Notice Letters

May 28, 2021
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Request for Member Reassignment Form

May 28, 2021
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Provider Inquiry Form

May 28, 2021
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Transportation Provider Application

May 28, 2021
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Outpatient Clinical Laboratory Provider Application

May 28, 2021
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Durable Medical Equipment Provider Application

May 28, 2021
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Organizational Provider Application

May 28, 2021
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Allied Health Professional Credentialing Application

May 28, 2021
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Non-Physician Medical Practitioner Application

May 28, 2021
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California Participating Practitioner Application

May 28, 2021
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Ntaub ntawv rau kab mob COVID-19

May 28, 2021
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Patient Complaint/Grievance Tracking Log

May 28, 2021
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Member Appointment No-Show Notification

May 28, 2021
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Certification Regarding Lobbying – Exhibit D(F) Att 1 and 2

May 28, 2021
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Certification Regarding Debarment Suspension, Ineligibility and Voluntary Exclusion

May 28, 2021
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Transportation Services Request Form

May 28, 2021
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Physician Certification Statement of Medical Necessity for NEMT

May 28, 2021
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Physician Orders for Life-Sustaining Treatment (POLST)

May 28, 2021
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Medication Management Agreement (MMA)

May 28, 2021
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Medical Clearance for General Anesthesia or IV Sedation for Dental Procedures

May 28, 2021
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Medi-Cal Provider-Preventable Conditions Reporting Portal

May 28, 2021
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Consent for Sterilization or Hysterectomy Sample Form

May 28, 2021
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Community Based Adult Services (CBAS) Inquiry Form

May 28, 2021
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Long Term Care Treatment Authorization Request

May 28, 2021
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Authorization Status Request

May 28, 2021
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Provider Change Request (PCR)

May 28, 2021
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Case Management Referral Form

May 28, 2021
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California Advance Health Care Directive Form

May 28, 2021
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Other Health Coverage (OHC) Referral Form

May 28, 2021
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Provider Identified Overpayment Form

May 28, 2021
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Credit Balance Report

May 28, 2021
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Corrected Claim Submission Form

May 28, 2021
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Pass Through/Supplemental Payments FAQ

May 28, 2021
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Remittance Advice Explain Codes

May 28, 2021
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Remittance Advice Guide

May 28, 2021
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EDI Companion Guide – 270/271 Information

May 28, 2021
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EDI Companion Guide – 276/277 Information

May 28, 2021
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EDI Companion Guide – 837/835 Trading Partner Information

May 28, 2021
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EDI Companion Guide – Transaction Instruction

May 28, 2021
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EDI Claims Enrollment Form Instructions

May 28, 2021
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EDI Claims Enrollment Form

May 28, 2021
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HEDIS Code Set

May 28, 2021
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HEDIS FAQ Guide

May 28, 2021
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Chronic and Persistent Conditions Health Measures

May 28, 2021
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Child and Adolescent Health Measures

May 28, 2021
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Behavioral Health Measures

May 28, 2021
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Women’s Health Measures

May 28, 2021
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Procedure Reimbursement Rate Request

May 26, 2021
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HEDIS Resources

May 21, 2021
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Kev Sib tham Hauv Vis Dis Aus (Video) lossis Hu Xov Tooj Nrog Kws Kho Mob (Telehealth)

May 19, 2021
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DHCS Medical Record Review (MRR) Checklist

May 14, 2021
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Infection Control: Spore Testing Job Aid

May 14, 2021
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DHCS Facility Site Review (FSR) Checklist

May 14, 2021
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FSR Critical Elements: Interim Monitoring Form

May 14, 2021
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DHCS Vaccine Recommendations During COVID-19

May 13, 2021
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COVID-19 Vaccine Administration for Providers

May 12, 2021
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PCP Blood Lead Testing Flyer

May 12, 2021
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Initial Health Appointment Billing Code List

May 12, 2021
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Kev Pab Cuam Tswj Kev Tu Xyuas

May 11, 2021
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Physical Accessibility Review Survey

May 11, 2021
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Medical Record Review

May 11, 2021
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Facility Site Review

May 11, 2021
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Unhealthy Alcohol Screening and Behavioral Counseling

May 11, 2021
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Staying Healthy Assessment

May 11, 2021
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Initial Health Assessment

May 11, 2021
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Cov Kev Them Nyiaj Raws Tus Nqi

May 11, 2021
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Cov Kev Txhawb Zog Rau Tus Tswvcuab

May 11, 2021
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Immunization Resources

May 11, 2021
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HEDIS

May 11, 2021
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Kev Pab Qhia Txog Kev Noj Qab Haus Huv thiab Kev Pab Tswj Kab Mob

May 11, 2021
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Provider Directory Information Attestation Form

May 10, 2021
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Txoj Kev Muab Kev Kawm Qhia Rau Cov Kws Pab Kho Mob Tshiab

May 10, 2021
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Provider Credentialing Applications and Policies

May 10, 2021
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Yuav Koom Tau Li Cas

May 10, 2021
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Vim Li Cas Ho Koom Nrog

May 10, 2021
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Cov Kev Pab Kho Mob

May 7, 2021
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Koom Nyob Hauv Peb Pab Pawg Koom Tes

May 7, 2021
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Cov Ntsiab Lus Txhais

May 7, 2021
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Medical Nutrition Therapy Benefit Quick Reference Guide

May 7, 2021
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Treatment Authorization Request (TAR)

May 7, 2021
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Prior Authorization Information Request for Injectable Drugs

May 6, 2021
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Synagis Statement of Medical Necessity

May 6, 2021
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Provider Portal Account Request Form

May 6, 2021
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Prior Authorization Criteria

May 6, 2021
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Prescription Drug Prior Authorization or Step Therapy Exception Request Form

May 6, 2021
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Pharmacy Formulary

May 6, 2021
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Pharmacy Services

May 6, 2021
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Alliance Care IHSS Daim Ntawv Qhia Txog Cov Kev Pab Kho Mob Uas Txais Tau thiab Cov Kev Fajseeb Kho Mob

May 5, 2021
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Alliance Care IHSS Daim Ntawv Qhia Txog Cov Kev Kho Mob Uas Pab Them Rau

May 5, 2021
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Alliance Kev Saib Xyuas IHSS Phau Ntawv Rau Tus Tswvcuab

May 5, 2021
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Lus Qhia Txog Koob Txhaj Tshuaj Tiv Thaiv Kab Mob COVID-19 rau Cov Tswvcuab Medi-Cal

May 4, 2021
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Promoting Cultural and Linguistic Competency

May 4, 2021
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A to Z Glossary of Spanish & Hmong Terms

May 4, 2021
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Interpreter Services Quality Assurance Form

May 3, 2021
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Tips For Working With Interpreters

May 3, 2021
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Interpreter Services Provider Quick Reference Guide

May 3, 2021
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Face-to-Face Interpreter Request Form

May 3, 2021
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Cov Kev Pab Cuam Kab Lis Kev Cai thiab Txhais Lus

May 3, 2021
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Daim Ntawv Thov Pab Pawg Pab Tswv Yim Rau Cov Kev Pab Cuam Tswv Cuab

April 30, 2021
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Blood Lead Testing Flyer

April 30, 2021
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California Management Guidelines: Childhood Lead Poisoning

April 30, 2021
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Standard of Care Guidelines: Childhood Lead Poisoning

April 30, 2021
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Depression Tool Kit

April 29, 2021
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USPSTF Recommendations for Primary Care Practice

April 29, 2021
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Preventable Emergency Care Visit Diagnosis Tip Sheet

April 29, 2021
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Daim Qhia Txog Cov Kev Kho Mob Uas Pab Them Rau

April 28, 2021
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Medi-Cal Phau Ntawv Qhia Siv Rau Tswv Cuab

April 28, 2021
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Alliance Cov Cai Rau Lwm Txoj Hauv Kev Mus Txais Tau Kev Pab Kho Mob (Alliance Alternative Access Standards)

April 28, 2021
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Best Practices for Reducing Patient No-Shows Tip Sheet

April 27, 2021
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Ambulatory Care Sensitive Admissions Tip Sheet

April 27, 2021
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Well-Child Visits in the First 15 Months of Life Tip Sheet

April 27, 2021
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Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet

April 27, 2021
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Tuberculosis (TB) Risk Assessment – Exploratory Measure Tip Sheet

April 27, 2021
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Preventable Emergency Visits Tip Sheet

April 27, 2021
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Maternity Care: Prenatal Tip Sheet

April 27, 2021
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Maternity Care: Postpartum Tip Sheet

April 27, 2021
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Plan All-Cause Readmissions Tip Sheet

April 27, 2021
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Lead Screening in Children – Exploratory Measure Tip Sheet

April 27, 2021
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Initial Health Assessment Tip Sheet

April 27, 2021
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Diabetic HbA1c Poor Control >9% Tip Sheet

April 27, 2021
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Developmental Screening in the First 3 Years Tip Sheet

April 27, 2021
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Controlling High Blood Pressure – Exploratory Measure Tip Sheet

April 27, 2021
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Immunizations: Children (Combo 10) Tip Sheet

April 27, 2021
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Chlamydia Screening in Women – Exploratory Measure Tip Sheet

April 27, 2021
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Child and Adolescent Well-Care Visits Tip Sheet

April 27, 2021
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Cervical Cancer Screening Tip Sheet

April 27, 2021
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Child and Adolescents BMI Assessment Tip Sheet

April 27, 2021
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Breast Cancer Screening Tip Sheet

April 27, 2021
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Application of Fluoride Varnish Tip Sheet

April 26, 2021
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Asthma Medication Ratio Tip Sheet

April 26, 2021
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Antidepressant Medication Management Tip Sheet

April 26, 2021
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Immunizations: Adult – Exploratory Measure Tip Sheet

April 26, 2021
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Programmatic Measure Benchmarks & Performance Improvement

April 26, 2021
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Provider Portal User Guide

April 26, 2021
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Provider Portal Quick Reference

April 26, 2021
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Provider Portal Frequently Asked Questions

April 26, 2021
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What’s New for the Care-Based Incentive Program

April 26, 2021
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CBI Technical Specifications

April 23, 2021
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90-Day Referral Completion – Exploratory Measure Tip Sheet

April 23, 2021
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Cov Xov Xwm Qhia Rau Kws Kho Mob

April 23, 2021
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Phau Ntawv Rau Tus Kws Kho Mob

April 22, 2021
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Phau Ntawv Teev Npe Cov Kws Kho Mob

April 22, 2021
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Immunizations: Adolescents Tip Sheet

April 22, 2021
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Care-Based Incentive (CBI) Summary

April 20, 2021
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Care-Based Incentive Resources

April 20, 2021
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Care-Based Incentive

April 20, 2021
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Kev Pab Saib Xyuas Kho Mob Kom Zoo

April 20, 2021
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Kev Pab Tswj Kho Mob

April 20, 2021
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Cov Kev Pab Rau Neeg Zej Zog

April 13, 2021
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Neeg zej zog muaj kev noj qab haus huv

April 13, 2021
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Nyob Nrog Txoj Kev Noj Qab Nyob Zoo

April 8, 2021
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Kev Tswj Tus Kab Mob

April 8, 2021
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Qhov Kev Npaj Kho Mob Rau Cov Menyuam Yaus Pab Neeg Tawm Tswvyim Los Pab Cov Tsev Neeg (Whole Child Model Family Advisory Committee; WCMFAC)

March 31, 2021
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Webinars and Training

March 30, 2021
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Provider Resources

March 30, 2021
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Capital Program

March 29, 2021
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Partners for Healthy Food Access Program

March 29, 2021
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Provider Recruitment Program

March 29, 2021
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How to Apply

March 26, 2021
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Rau Cov Zej Zog

March 25, 2021
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Cov Chaw Haujlwm Muab Kev Kho Mob Ceev hauv Lub Cheeb Nroog Merced

March 24, 2021
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Cov Chaw Haujlwm Muab Kev Kho Mob Ceev hauv Lub Nroog Santa Cruz

March 24, 2021
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Daim Ntawv Thov Nkag Qhov Kev Npaj Kho Mob Rau Cov Menyuam Yaus Pab Neeg Tawm Tswvyim Los Pab Cov Tsev Neeg

March 19, 2021
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Tiv tauj rau peb | Hu Dawb: 800-700-3874

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DAIM NTAWV FOOS THOV HAIS KEV TSIS TXAUS SIAB
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Txoj Cai Rau Kev Saib Xyuas Kho Mob Txuas Ntxiv

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