See billing +Rx updates, member assistance and more!

Sharing immigration and health care resources with members

The Alliance is sharing updated resources to help members navigate immigration and health care concerns. These include information about Medi-Cal eligibility, local and state legal aid, and support programs available regardless of immigration status. Key points for members: 

• Medi-Cal eligibility remains unchanged — all who qualify can still receive coverage.

• Starting January 2026, some members’ health care benefits and access may change.

• Members should continue seeing their doctor for needed care.

To make it easier for members to access care from home, we’re promoting multiple no-cost telehealth options:

• Their own doctor, if phone or video visits are offered.

• 얼라이언스 간호사 상담 라인 (844-971-8907).

• 로켓 닥터 (844-996-3763 or online).

• Zócalo Health (213-855-3465 or online).

Provider request: If your practice offers phone or video visits, please notify your Provider Relations Representative. We will share this information with members who call to request a provider that offers telehealth services. For the full list of immigration and health care resources, including county-specific programs, visit the Immigration Help page on the Alliance website. If you have questions or updates to share, contact a Provider Relations Representative at 800-700-3874, 내선 5504.

New webinar: How Cal-MAP equips providers to address youth mental health

Attend an upcoming webinar about the California Child and Adolescent Mental Health Access Portal (Cal-MAP) on Thursday, Sept. 4 from noon to 1 p.m. This webinar is part of the Implementation with Intention training series. Cal-MAP is a no-cost consultation program that supports primary care and school-based providers in delivering timely, high-quality mental health care to youth ages 0–25. In this webinar, we will provide an overview of Cal-MAP’s services, including consultation on screening, diagnosis and treatment from child psychiatrists, as well as resource and referral guidance from licensed social workers.

세부

• When: Thursday, Sept. 4, 2025, from noon to 1 p.m.

• 장소: 온라인.

• Register: 온라인 등록.

주요 주제

• How Cal-MAP expands access to youth mental health care.

• How to use the Cal-MAP portal and service offerings to support children, youth and families impacted by ACEs, toxic stress and other behavioral health issues.

• Learn about clinical impacts that have been identified by Cal-MAP users.

• Identify resources for providers and families based on specific topics or mental health concerns.

Speaker: Petra Steinbuchel, MD

Physician-administered drug changes to know, effective Sept. 1, 2025

얼라이언스(Alliance)는 의사 투여 약물 혜택에 대한 변경 사항을 적용했습니다. 사전 승인(PA) 기준은 다음 링크에서 확인하실 수 있습니다. 웹사이트. The changes are as follows:

얼라이언스(Alliance)는 다음과 같은 약국 정책을 업데이트했습니다. 정책 사본을 요청하시려면 얼라이언스 약국부(831-430-5507)로 전화해 주십시오.

• 403-1114 Continuing Pharmacy Care for New Members.

• 403-1123 Drugs for the Treatment of Sexual or Erectile Dysfunction.

• 403-1124 Drug-Recall Procedure.

• 403-1126 Pharmaceutical Services Access.

• 403-1128 Other Non-Formulary Drugs.

• 403-1137 Drugs Previously Approved by the Alliance.

• 403-1139 Opioid Utilization Review.

• 403-1143 Drug Utilization Review.

• 403-1144 Pharmacy Provision of Family Planning Services.

• 403-1145 Pharmacy 340B Program.

• 403-1147 CCS Pharmaceuticals Policy.

• 403-1148 Mail Order Pharmacy Services.

• 403-1152 Site of Care.

• 403-1153 Botulinum Toxin for Spasticity and Dystonia in Children.

• 403-1155 Beyfortus (Nirsevimab).

2025-2026 Influenza season billing + coding updates

Vaccine composition for the 2025-26 U.S. influenza season

The FDA recommends that the trivalent formulation of egg-based influenza vaccines for the 2025-2026 U.S. influenza season contain the following:

• An A/Victoria/4897/2022 (H1N1) pdm09-like virus.

• An A/Croatia/10136RV/2023 (H3N2)-like virus.

• AB/오스트리아/1359417/2021(B/빅토리아 계통) 유사 바이러스.

The FDA recommends that the trivalent formulation of cell- or recombinant-based influenza vaccines for the 2025-2026 U.S. influenza season contain the following:

• An A/Wisconsin/67/2022 (H1N1) pdm09-like virus.

• An A/District of Columbia/27/2023 (H3N2)-like virus.

• AB/오스트리아/1359417/2021(B/빅토리아 계통) 유사 바이러스.

VFC 프로그램 The Vaccines for Children (VFC) program is a federally funded program that provides vaccines at no cost to eligible children who might not otherwise be vaccinated because of inability to pay. Children under age 19 are eligible for the VFC program. Children are eligible if they are any of the following:

• 메디케이드 적용 대상입니다.

• 무보험.

• 보험 미비.

• 미국 인디언/아메리카 원주민.

VFC 스톡을 사용하는 경우, 백신 코드에 수정자 SL을 추가합니다.. Modifier SL indicates VFC stock used and only allows reimbursement for the administration of vaccine.Per Medi-Cal guidelines: “Medi-Cal vaccine injection codes billed for recipients eligible to receive VFC program vaccines will be reimbursed only in documented cases of vaccine shortage, disease epidemic, vaccine delivery problems or instances when the recipient does not meet the special circumstances required for VFC special-order vaccines. A provider’s non-enrollment in the VFC program is not a justified exception.”However, the Alliance will make an exception for non-VFC providers.

청구 방법

• SL 수정자와 함께 CPT 코드를 청구하지 마세요.

• CMS 청구서의 상자 19 또는 UB-04 청구서의 상자 80에 "비 VFC"를 문서화합니다.

• Send the claim to CCAH (the Alliance), Attention: Sharlene Gianopoulos.

모든 청구는 UB-04, CMS-1500 또는 이와 동등한 전자 양식으로 청구되어야 합니다.

*케어 기반 인센티브(CBI)에는 예방접종 등록을 위한 올바른 CVX 코드가 필요합니다. 

Patients/parents must not “opt out” of immunization registry sharing for vaccine information to be available. A patient/parent may request to change their sharing status at any time and be updated through the registry’s website.

For more information, please see disclosures on registry websites.

• California Immunization Registry-CAIR
• 건강 Futures Immunization Registry (RIDE)