Prepare for audits, upcoming webinar + APL updates  

Prepare for IHA and EPSDT audits 

Starting April 1, 2025, the Alliance will begin contacting provider offices for our Initial Health Appointment (IHA) and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) medical record audits. We will contact providers via phone, email and fax for the information below. Prepare now to be ready!      

 Providers will need to submit the following medical records:   

• Office visit notes for requested date of service.  

• Screenings from any date of service:  

• Lead screening and results for members ages 6 to 72 months.  

• Developmental screenings.  

• Depression and drug/alcohol screening for members ages 11 years and up. This includes pregnant members.   

• Risk assessment:  

• Social determinates of Health for members of all ages.  

• Adverse Childhood Experiences (ACE) for members ages 1 to 20.   

• Cognitive screening for members ages 65+ without Medicare (IHA only).  

• Documentation supporting use of dummy code (IHA only).  

• Documentation of referral follow up (EPSDT only).   

Best practices  

• We request that all medical records be returned within 5-7 business days of the request via fax number 831-430-5685.  

• Required documentation will be listed on the request.  

• Submit medical records for all services that were submitted on the claim.  

Questions?  

If you have any questions regarding the audits, please email us at [email protected]. We thank you for your office’s time and cooperation in submitting the requested information!  

Reminder: Attend the Oral Health & Fluoride Varnish Application in the Medical Setting webinar!    

The Alliance will be hosting this lunch and learn webinar for providers, nurses and medical assistants on Thursday, April 3, 2025, from noon to 1 p.m.    

To register, visit our website or contact an Alliance Provider Relations Representative at 800-700-3874, ext. 5504.   

Review All Plan Letter (APL) and legislative updates   

The Department of Health Care Services has made updates to multiple All Plan Letters (APL). These changes are important to know, as they may impact how you provide services.    

For more information about the updated APLs and others, you can visit our All Plan Letters web page. You can also find related Alliance policies and procedures in the Alliance Provider Manual.      

There are also implemented legislative updates that might change how you provide services to members. Please review relevant health care legislative bills on our website.