ECM/CS updates + new pediatric resources
Welcome, Mariposa and San Benito county providers!
After going live on January 1 as the Medi-Cal managed care plan for Mariposa and San Benito counties, we would like to extend a warm welcome to all providers who have recently joined our network in these areas. It is because of our dedicated providers that we are able to deliver quality health care to over 456,000 members across five counties.
We look forward to nurturing strong provider partnerships in Mariposa and San Benito counties, and we are grateful for providers across all counties for your continued collaboration and commitment as we start a new year serving Medi-Cal members together.
New resources for pediatric screenings and vaccines
Pediatric screening and vaccine rates for Alliance members are integral to the Healthcare Effectiveness Data and Information Set (HEDIS) as well as our Care-Based Incentive (CBI) measures. Additionally, a significant focus of the Alliance Strategic Plan is to eliminate health disparities and achieve optimal health outcomes for children and youth.
To support providers in delivering the best possible quality of care to pediatric patients, the Alliance has added some new resources on pediatric screenings and vaccines to our Health Assessments webpage.
Pediatric Screening Tool
The Pediatric Screening Tool includes codes, restrictions, modifiers, standardized tests and any applicable rules for pediatric screenings.
Pediatric Vaccine Tools
The Pediatric Vaccine Tools guide is intended to support providers with information about vaccines connected to the Childhood Immunization Status (CIS) and (IMA) measures in HEDIS and CBI. This document covers vaccine brand names, CPT and CVX codes, age restrictions, frequency limits, modifiers and billing rules.
Thank you for your continued commitment to provide accessible, quality health care guided by local innovation!
2024 updates to ECM/CS services
As of January 1, 2024, Enhanced Care Management and Community Supports (ECM/CS) are available to Alliance members in Mariposa and San Benito counties, making these services open to eligible Alliance members in all five counties we serve.
Additionally, there are two newly eligible populations of focus for ECM services:
- Birth Equity.
- Adults and youth transitioning from incarceration (post-release services only).
Referring members to ECM/CS services
The Department of Health Care Services (DHCS) emphasizes how important it is for managed care plans like the Alliance to source most Enhanced Care Management and Community Supports (ECM/CS) referrals from community providers.
Providers or requesting entities may refer members to ECM and CS services through the following channels:
- The Alliance Provider Portal.
- Online referral on our website.
- Call 831-430-5512.
- Submit a Treatment Authorization Request (TAR) form with the appropriate documentation attached. Providers may submit TAR forms by email to [email protected] or fax them to 831-430-5819.
To learn more about ECM/CS programs, including how to refer Alliance members to ECM and CS, visit our ECM/CS provider page.
