Provider Digest | Issue 40

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CBI reports, EDV audit, new care management system + more

Q3 2023 CBI reports are now available

Your clinic’s Q3 Care Based Incentive (CBI) reports are now available to review and download from the Provider Portal. This is a good opportunity to review your clinic’s performance, reconcile the information to your electronic health record (EHR) and submit missing information via the Data Submission Tool.

All Data Submission Tool submissions need to be uploaded by Thursday, February 29, 2024, at 11:59 p.m.

If you have questions or would like to request a CBI forensics appointment to review your clinic’s performance, please contact your Provider Relations Representative at 800-700-3874, ext. 5504.

2024 DHCS encounter data validation (EDV) audit

Starting Feb. 1, 2024, the Health Services Advisory Group (HSAG) is conducting their annual Department of Health Care Services (DHCS) encounter data (claims) audit.

The audit study period is Jan. 1–Dec. 31, 2022. During the audit, HSAG will look for encounter data completeness and accuracy through medical record review.

The Alliance will begin contacting provider offices to request medical records in the beginning of February. Most requests will be made by fax, accompanied by a phone call to verify receipt of the request.

HSAG will randomly select one date of service (DOS) in the study period. Providers will need to submit medical records for the selected DOS. Additionally, providers will be required to select a second DOS closest to the sample DOS, with the same rendering provider when possible, and submit that medical record.

Note: This audit will occur simultaneously with the Healthcare Effectiveness Data and Information Set (HEDIS) audit. This means that provider offices may be receiving multiple medical record requests from the Alliance. However, the sample population and audit period will be different. We thank you for your office’s time and cooperation in submitting the requested information!

EDV audit best practices

We request that all medical records be returned within 5-7 business days of the request.

For paper charts, please apply a provider signature stamp next to handwritten provider signatures. This is so HSAG can match the provider signature to the provider submitted on the claim. Submit medical records for all services that were submitted on the claim.


If you have any questions regarding the HSAG encounter data validation audit, please email us at [email protected].

Free lecture series: How the Physiology of Generational & Historical Trauma Impacts Equity

Alliance providers are invited to join international lecturer, culturalist and trauma specialist Iya Affo for a free 48-hour lecture series, which runs from February 22 through October 10, 2024.

The Alliance encourages providers to attend to deepen their understanding of population health and factors impacting health equity when caring for our members.

The series will be held in a mostly virtual setting, with the option to attend in person for the first and last sessions. The in-person gatherings will be held at the Merced County Office of Education’s Downtown Professional Development Center at 1715 Canal Street in Merced.

Learn more on our website.

Alliance to implement new care management system Jiva

This spring, the Alliance is updating the Provider Portal to utilize a new care management system called Jiva. This shift in care management systems will facilitate improvements in the system of care for members, especially those with complex medical and social needs.

The Jiva platform provides better tools to support population and individual care management, more flexible reporting, improved integration with other applications and reliable software support. We aim to implement this system transition with no interruption to routine business operations.

We are committed to providing comprehensive support for providers through this transition. The Alliance will be providing webinars, training resources and an updated Provider Portal User Guide to ensure care teams are set up for success.

More information about this system upgrade will be shared in the next few weeks. If you have questions, please call the Alliance’s Care Management team at 800-700-3874, ext. 5512.