Be ready! Audits, trainings and Medi-Cal updates to know

Prepare for IHA and ESPDT audits!

As of Oct. 1, 2025, the Alliance will begin conducting our Initial Health Appointment (IHA) and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) medical record audits.  The Alliance will begin contacting provider offices via email, fax and phone calls to request specific medical records. 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 testing and results (members 6-72 months).
  • Developmental screenings.
  • Depression and drug/alcohol screening (11 years and up).
  • Maternal depression screening.
  • Risk assessment (one of the following).
    • Social determinates of Health (all ages).
    • Adverse Childhood Experiences (ACE) (1-20 years of age).
    • Cognitive screening for members 65+ years without Medicare only (IHA only).
• Documentation supporting use of dummy code.
• 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! 

TotalCare (HMO D-SNP) Model of Care Training

The Alliance TotalCare (HMO D-SNP) website is now live and annual enrollment period begins Oct. 15! If you are a TotalCare provider, you are required to complete the 2026 Model of Care (MOC) Provider Training. The Centers for Medicare & Medicaid Services (CMS) require MOC training to be completed upon onboarding and annually thereafter. 

​Model of Care training is required to be completed by all employed, contracted and temporary staff, including providers (in or out of network) routinely participating as part of the member’s interdisciplinary care team. Provider staff may include:  

• Care coordination staff.  

• Administrative staff.  

• Other clinical or support staff.  

To complete this training, you must review the training slide deck on our website and complete the attestation.  

Be on the lookout for future D-SNP trainings on our website on our Webinars and Training page.  

If you would like to join our D-SNP provider network, email us at [email protected]. Learn more on our Become a D-SNP Provider page. 

Help members stay covered and informed

The Alliance is preparing members for Medi-Cal changes coming in January 2026. While most will remain eligible, some may see changes and many have questions about how immigration status affects coverage. Providers can play a key role in helping members stay informed and covered.  

How you can help members today  

• Remind members to complete redetermination paperwork on time to avoid losing coverage.  

• Encourage new eligible members to enroll before the end of 2025.  

Share our easy-to-use resources with patients  

We have these resources you can share with patients and have in your office:   

• Flyers with key reminders and telehealth options.    

• A dedicated landing page with the latest Medi-Cal updates. This webpage has information on how to enroll in and renew Medi-Cal coverage, what’s changing in 2026 and provides information on immigration status and health care.  

Our outreach efforts  

We’re meeting members where they are—through ads in DMV offices, streaming platforms, geofencing campaigns and social media content.   

Our Community Engagement team is partnering with local eligibility offices and Health Care Collaboratives to make sure members get accurate information and support.  

Thank you for partnering with us to support members. For questions or updates, contact a Provider Relations Representative at 800-700-3874, ext. 5504.  

Reminder: Save the date for our November immunization webinar!

Join us for an immunization webinar on Wednesday, Nov. 5, 2025, from noon to 1 p.m.    

Speaker from Partnership Health Plan of California Dr. Mohamed Jalloh Pharm.D. DCPS, will be hosting the webinar, along with our very own Interim Chief of Health Equity Dianna Myers, MD.    

Details and registration   

When: Wednesday Nov. 5, 2025, from noon to 1:00p.m.   

Where: Online via Microsoft Teams.    

Register today by visiting our website or contact a Provider Relations Representative at 800-700-3874, ext. 5504.