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Antidepressant Medication Management Tip Sheet
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Programmatic Measure Benchmarks & Performance Improvement
Asthma Medication Ratio Tip Sheet
90-Day Referral Completion – Exploratory Tip Sheet
Antidepressant Medication Management Tip Sheet
Application of Fluoride Varnish Tip Sheet
Immunizations: Children (Combo 10) Tip Sheet
Chlamydia Screening in Women – Exploratory Measure Tip Sheet
Child and Adolescent Well-Care Visits Tip Sheet
Cervical Cancer Screening Tip Sheet
Child and Adolescents BMI Assessment Tip Sheet
Breast Cancer Screening Tip Sheet
Well-Child Visits in the First 15 Months of Life Tip Sheet
Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet
Tuberculosis (TB) Risk Assessment – Exploratory Tip Sheet
Preventable Emergency Visits Tip Sheet
Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet
Maternity Care: Prenatal Tip Sheet
Maternity Care: Postpartum Tip Sheet
Plan All-Cause Readmissions Tip Sheet
Lead Screening in Children – Exploratory Measure Tip Sheet
Initial Health Assessment Tip Sheet
Diabetic HbA1c Poor Control >9% Tip Sheet
Developmental Screening in the First 3 Years Tip Sheet
Controlling High Blood Pressure – Exploratory Measure Tip Sheet
Immunizations: Children (Combo 10) Tip Sheet
Best Practices for Reducing Patient No-Shows Tip Sheet
Ambulatory Care Sensitive Admissions Tip Sheet
Depression Tool Kit
USPSTF Recommendations for Primary Care Practice
Preventable Emergency Care Visit Diagnosis Tip Sheet
Blood Lead Testing Flyer
Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents Tip Sheet
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For Members
Get Started
Member ID Card
Find a Doctor
Alliance Alternative Access Standards
About Your Health Plan
Frequently Asked Questions
Mariposa and San Benito
Get Care
Primary Care
Approvals for Care
Nurse Advice Line
Prescriptions
Medications and Your Health
Introducing Medi-Cal Rx
Urgent Care
Urgent Visit Access – Merced County
Urgent Visit Access – Monterey County
Urgent Visit Access – Santa Cruz County
Behavioral Health
Transportation Services
Enhanced Care Management and Community Supports
Other Services
Dental and Vision
Family Planning
Medical Equipment
Out-of-Area Services
Member Services
Access Your Health Information
COVID-19 Information
General COVID-19 Information
COVID-19 Testing and Treatment
COVID-19 Vaccine Information
Language Assistance
File a Grievance
California Children’s Services
Join an Advisory Group
Member Services Advisory Group (MSAG)
Member Services Advisory Group Application
Whole Child Model Family Advisory Committee (WCMFAC)
Member News
Online Self-Service
Replace ID Card
Choose Primary Doctor
Insurance Information
Update Contact Information
Information Release
Privacy Request
Request Personal Representative
Member Reimbursement Claim Form
Member Online Account
Confidential Communications Request Form
Find a Form
Health and Wellness
Health Rewards Program
Wellness Resources
For Providers
Join Our Network
Why Join
How to Join
Provider Application Request
Provider Credentialing Applications and Policies
Re-Credentialing
New Provider Orientation
Manage Care
Behavioral Health
California Children’s Services
Clinical Resources
Care Management
Complex Case Management and Care Coordination
Pain Management and Substance Use Resources
Seniors and Disabilities
Nurse Advice Line
Referrals and Authorizations
Telehealth Services
Cultural and Linguistic Services
Face-to-Face Interpreter Request Form
Interpreter Services Provider Quick Reference Guide
Interpreter Services Quality Assurance Form
A to Z Glossary of Spanish & Hmong Terms
Enhanced Care Management and Community Supports
Enhanced Care Management (ECM)
Community Supports (CS)
ECM/CS Referrals
ECM/CS Trainings
Health Education and Disease Management
Health Education Programs
Breastfeeding Support and Breast Pump Benefit
Disease Management Programs
Health Resources
Pharmacy
Medi-Cal Rx
Pharmacy Formulary
Prescription Drug Prior Authorization
Prior Authorization Criteria
Prior Authorization Information Request for Injectable Drugs
Synagis Statement of Medical Necessity
Treatment Authorization Request (TAR)
Medical Nutrition Therapy Benefit Quick Reference Guide
Quality of Care
Care-Based Incentive
Care-Based Incentive Resources
Care-Based Incentive (CBI) Summary
CBI Technical Specifications
Antidepressant Medication Management Tip Sheet
Immunizations: Adult – Exploratory Measure Tip Sheet
Immunizations: Adolescents Tip Sheet
Programmatic Measure Benchmarks & Performance Improvement
Asthma Medication Ratio Tip Sheet
90-Day Referral Completion – Exploratory Tip Sheet
Antidepressant Medication Management Tip Sheet
Application of Fluoride Varnish Tip Sheet
Immunizations: Children (Combo 10) Tip Sheet
Chlamydia Screening in Women – Exploratory Measure Tip Sheet
Child and Adolescent Well-Care Visits Tip Sheet
Cervical Cancer Screening Tip Sheet
Child and Adolescents BMI Assessment Tip Sheet
Breast Cancer Screening Tip Sheet
Well-Child Visits in the First 15 Months of Life Tip Sheet
Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet
Tuberculosis (TB) Risk Assessment – Exploratory Tip Sheet
Preventable Emergency Visits Tip Sheet
Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet
Maternity Care: Prenatal Tip Sheet
Maternity Care: Postpartum Tip Sheet
Plan All-Cause Readmissions Tip Sheet
Lead Screening in Children – Exploratory Measure Tip Sheet
Initial Health Assessment Tip Sheet
Diabetic HbA1c Poor Control >9% Tip Sheet
Developmental Screening in the First 3 Years Tip Sheet
Controlling High Blood Pressure – Exploratory Measure Tip Sheet
Immunizations: Children (Combo 10) Tip Sheet
Best Practices for Reducing Patient No-Shows Tip Sheet
Ambulatory Care Sensitive Admissions Tip Sheet
Depression Tool Kit
USPSTF Recommendations for Primary Care Practice
Preventable Emergency Care Visit Diagnosis Tip Sheet
Blood Lead Testing Flyer
Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents Tip Sheet
Screening for Depression and Follow-Up Plan Tip Sheet
What’s New
Health Assessments
HEDIS
HEDIS Resources
HEDIS Code Set
HEDIS FAQ Guide
Immunization Resources
Member Incentives
Site Reviews
Facility Site Review
Infection Control: Spore Testing Job Aid
DHCS Facility Site Review (FSR) Checklist
FSR Critical Elements: Interim Monitoring Form
Medical Record Review
DHCS Medical Record Review (MRR) Checklist
Physical Accessibility Review Survey
Value-Based Payments
Resources
COVID-19
Claims
View/Submit a Claim
Forms
Provider Directory Update Form
News
Provider Directory
Provider Manual
All Plan Letters
Timely Access to Care
Webinars and Training
Provider Events Calendar
Provider Portal
Using the Provider Portal
Frequently Asked Questions
Provider Portal User Guide
Provider Portal Quick Reference
Provider Portal Account Request Form
Procedure Code Lookup Tool
Provider news you can use
Check out the latest Provider Digest!
For Communities
Healthy Communities
Your Health Matters
Community Events
Community-Based Adult Services
Community Health Worker Benefit
Community Resources
Doula Services Benefit
Enhanced Care Management and Community Supports
Medi-Cal Capacity Grants
Access to Care
Equity Learning for Health Professionals Program
Healthcare Technology Program
Workforce Recruitment Programs
CHW Recruitment Program
MA Recruitment Program
Provider Recruitment Program
Healthy Beginnings
Home Visiting Program
Parent Education and Support Program
Healthy Communities
Community Health Champions
Partners for Active Living Program
How to Apply
Grants at Work
Community Publications
Community Impact Reports
The Beat
E-Newsletter
Don’t miss a beat
Subscribe to our community newsletter The Beat
Health Plans
Medi-Cal
Alliance Care IHSS
Alliance Care IHSS Price Transparency Tool
Update your Medi-Cal
Make sure you’re covered!
About Us
About the Alliance
Fact Sheet
Mission, Vision and Values
Strategic Plan 2022-2026
Leadership
Public Meetings
Careers
Contact Us
News
Community News
Member News
Provider News
Meetings and Events
Newsroom
We are hiring!
Join our mission-driven team.
Pending 2022 Annual Review
2021 Bridge Plan
March 5, 2021
Pending 2022 Annual Review
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Pending Comms Review
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2021 PNA Report (Tri-county)
February 16, 2022
Branding Update Needed
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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2022 PNA Report (Tri-county)
July 11, 2022
Branding Update Needed
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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90-Day Referral Completion – Exploratory Measure Tip Sheet
April 23, 2021
CBI
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CBI Resources
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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A to Z Glossary of Spanish & Hmong Terms
May 4, 2021
Branding Update Needed
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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About the Alliance
January 22, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Adult Enhanced Care Management Provider Referral Form (age 21 and over)
January 4, 2022
ECM
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ECM Forms
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Enhanced Care Management
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents Tip Sheet
January 1, 2022
CBI
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CBI Resources
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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All Plan Letters
May 24, 2023
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Alliance Alternative Access Standards
April 28, 2021
Alternative Access
,
Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
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Alliance Care IHSS Benefits Matrix
May 5, 2021
IHSS
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Alliance Care IHSS Member Handbook
May 5, 2021
IHSS
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Alliance Care IHSS Price Transparency Tool
December 5, 2022
IHSS
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Alliance Care IHSS Summary of Benefits and Coverage
May 5, 2021
IHSS
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Alliance Care In-Home Supportive Services (IHSS)
January 19, 2021
IHSS
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Alliance Holidays
May 7, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Alliance Language Assistance Services
February 5, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Allied Health Professional Credentialing Application
May 28, 2021
Branding Update Needed
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Am I Eligible?
January 11, 2021
Medi-Cal
,
Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
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Am I Eligible?
January 19, 2021
IHSS
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Ambulatory Care Sensitive Admissions Tip Sheet
April 27, 2021
CBI
,
CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Antidepressant Medication Management Tip Sheet
April 26, 2021
CBI
,
CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Application of Fluoride Varnish Tip Sheet
April 26, 2021
CBI
,
CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Approvals for Care
February 3, 2021
Pending 2022 Annual Review
,
Pending Comms Review
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Pending Department Review
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Asthma
August 9, 2022
Pending 2022 Annual Review
,
Pending Comms Review
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Pending Department Review
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Asthma Education Benefit Description
June 14, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Asthma Education is Available for Your Alliance Patients
June 26, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Asthma Medication Ratio Tip Sheet
April 26, 2021
CBI
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CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
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Pending Department Review
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Asthma Self-Management Education Checklist
May 29, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Authorization Status Request
May 28, 2021
Branding Update Needed
,
Health Services
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Beacon Health Options Medi-Cal Provider FAQs
June 1, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Beacon Health Options Screening Guidelines for Autism
June 1, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Benefits
January 19, 2021
Medi-Cal
,
Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
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Benefits
January 19, 2021
IHSS
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Best Practices for Reducing Patient No-Shows Tip Sheet
April 27, 2021
CBI
,
CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Blood Lead Testing Flyer
April 30, 2021
CBI
,
CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Breast Cancer Screening Tip Sheet
April 27, 2021
CBI
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CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Breastfeeding
August 9, 2022
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Breastfeeding and Lactation Education Checklist
May 29, 2021
Pending 2022 Annual Review
,
Pending Comms Review
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Pending Department Review
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Breastfeeding Support and Breast Pump Benefit
June 1, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Breastfeeding Support and Breast Pump Benefit Clinical Health Education Benefit
May 31, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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California Advance Health Care Directive Form
May 28, 2021
Health Services
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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California Participating Practitioner Application
May 28, 2021
Branding Update Needed
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Capital Program
March 29, 2021
MCGP
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Care Management
May 11, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Care-Based Incentive
April 20, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Care-Based Incentive (CBI) Summary
April 20, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Carelon Care Management Referral Form
June 13, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Carelon Diagnostic Evaluation Form (Medi-Cal)
June 13, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Carelon Primary Care Provider (PCP) Referral Form
September 19, 2023
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Case Management Referral Form
May 28, 2021
Branding Update Needed
,
Health Services
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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CBI Technical Specifications
April 23, 2021
CBI
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CBI Resources
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Central California Alliance for Health
July 21, 2020
Pending 2022 Annual Review
,
Pending Comms Review
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Certification Regarding Debarment Suspension, Ineligibility and Voluntary Exclusion
May 28, 2021
Branding Update Needed
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Provider Services
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Certification Regarding Lobbying – Exhibit D(F) Att 1 and 2
May 28, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Provider Services
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Cervical Cancer Screening Tip Sheet
April 27, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Changes to Public Charge
November 22, 2022
Medi-Cal
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Checkups
August 9, 2022
Pending 2022 Annual Review
,
Pending Comms Review
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Pending Department Review
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Child and Adolescent Well-Care Visits Tip Sheet
April 27, 2021
CBI
,
CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Child and Adolescents BMI Assessment Tip Sheet
April 27, 2021
CBI
,
CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
Tags:
Chlamydia Screening in Women – Exploratory Measure Tip Sheet
April 27, 2021
CBI
,
CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Choose Primary Doctor
March 12, 2021
Member Forms - Find a Form
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Chronic Conditions
August 9, 2022
Pending 2022 Annual Review
,
Pending Comms Review
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Pending Department Review
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CHW Recruitment Program
April 7, 2023
MCGP
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Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
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Clinical Resources
May 7, 2021
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Colorectal Cancer Screening – Exploratory Measure Tip Sheet
December 14, 2022
CBI
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CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Community Based Adult Services (CBAS) Inquiry Form
May 28, 2021
Branding Update Needed
,
Health Services
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
,
Provider Forms
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Community Events
September 28, 2022
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Community Health Champions
May 12, 2023
MCGP
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Community Impact Reports
February 16, 2022
MCGP
,
Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
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Community Publications
February 24, 2022
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Community Resources
April 13, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Community Supports
December 15, 2022
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Community Supports (CS) Provider Information
August 23, 2023
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Community Supports: Environmental Accessibility and Adaptability (EAA) Provider Referral Form
December 22, 2022
Community Supports
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CS Forms
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Community Supports: Housing Provider Referral Form
January 4, 2022
Community Supports
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CS Forms
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Community Supports: Meals Provider Referral Form
December 22, 2022
Community Supports
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CS Forms
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Community Supports: Personal Care and Home Maker Services and Respite Services for Caregivers Provider Referral
July 7, 2023
Community Supports
,
CS Forms
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
,
Provider Forms
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Complex Case Management and Care Coordination
June 1, 2021
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Confidential Communications Request Form
June 22, 2022
Member Forms - Find a Form
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Consent for Sterilization or Hysterectomy Sample Form
May 28, 2021
Branding Update Needed
,
Health Services
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
,
Provider Forms
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Contact Us
January 23, 2021
Pending 2022 Annual Review
,
Pending Comms Review
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Controlling High Blood Pressure – Exploratory Measure Tip Sheet
April 27, 2021
CBI
,
CBI Resources
,
Pending 2022 Annual Review
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Corrected Claim Submission Form
May 28, 2021
Claims
,
Pending 2022 Annual Review
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Provider Forms
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COVID-19 Information
May 28, 2021
COVID-19
,
Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
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COVID-19 Testing and Treatment
September 25, 2023
COVID-19
,
Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
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COVID-19 Vaccine Administration for Providers
May 12, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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COVID-19 Vaccine Information
September 25, 2023
COVID-19
,
Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
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COVID-19 Vaccine Information for Medi-Cal Members
May 4, 2021
Flu Season 2021
,
Pending 2022 Annual Review
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COVID-19 Vaccine Information for Medi-Cal Members Flyer
May 4, 2021
COVID-19 Vaccine
,
Pending 2022 Annual Review
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COVID-19 Vaccine Information Videos
June 22, 2021
COVID-19
,
Pending 2022 Annual Review
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Pending Comms Review
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COVID-19: Information for Providers
June 18, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Credit Balance Report
May 28, 2021
Branding Update Needed
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Finance
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Crush COVID!
October 7, 2021
Flu Season 2021
,
Pending 2022 Annual Review
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Cultural and Linguistic Services
May 3, 2021
Pending 2022 Annual Review
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Dental and Vision
February 3, 2021
Pending 2022 Annual Review
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Depression Tool Kit
April 29, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Pending Comms Review
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Developer Application
October 4, 2021
Pending 2022 Annual Review
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Developer Questionnaire
November 17, 2021
Pending 2022 Annual Review
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Developer Resources
June 16, 2021
Pending 2022 Annual Review
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Developmental Screening in the First 3 Years Tip Sheet
April 27, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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DHCS Facility Site Review (FSR) Checklist
May 14, 2021
FSR
,
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Provider Forms
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DHCS Medical Record Review (MRR) Checklist
May 14, 2021
MRR
,
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Provider Forms
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DHCS Vaccine Recommendations During COVID-19
May 13, 2021
COVID-19
,
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Diabetes Eye Exam Services Resource List – English
June 25, 2021
Pending 2022 Annual Review
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Diabetes Eye Exam Services Resource List – Hmong
June 25, 2021
Pending 2022 Annual Review
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Diabetes Eye Exam Services Resource List – Spanish
June 25, 2021
Pending 2022 Annual Review
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Diabetes Self-Management Education Benefit Description
May 29, 2021
Pending 2022 Annual Review
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Diabetes/Prediabetes
August 9, 2022
Pending 2022 Annual Review
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Diabetic HbA1c Poor Control >9% Tip Sheet
April 27, 2021
CBI
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CBI Resources
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Disease Management Programs
May 29, 2021
Pending 2022 Annual Review
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Doula Provider Application
August 3, 2023
Branding Update Needed
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Pending 2022 Annual Review
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Provider Forms
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May 28, 2021
Branding Update Needed
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Provider Forms
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EDI Claims Enrollment Form
December 8, 2022
EDI
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Provider Forms
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May 28, 2021
EDI
,
Pending 2022 Annual Review
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EDI Companion Guide – 270/271 Information
May 28, 2021
EDI
,
Pending 2022 Annual Review
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EDI Companion Guide – 276/277 Information
May 28, 2021
EDI
,
Pending 2022 Annual Review
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EDI Companion Guide – 837/835 Trading Partner Information
May 28, 2021
EDI
,
Pending 2022 Annual Review
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EDI Companion Guide – Transaction Instruction
May 28, 2021
EDI
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Pending 2022 Annual Review
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Enhanced Care Management (ECM)
December 15, 2022
Pending 2022 Annual Review
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Enhanced Care Management (ECM) and Community Supports Provider Information
August 15, 2023
Pending 2022 Annual Review
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Enhanced Care Management (ECM) and Community Supports Provider Referrals
August 23, 2023
Pending 2022 Annual Review
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Enhanced Care Management (ECM) and Community Supports Trainings
August 11, 2023
Pending 2022 Annual Review
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Enhanced Care Management (ECM) Provider Information
August 23, 2023
Pending 2022 Annual Review
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Enhanced Care Management and Community Supports for Members
August 18, 2023
Pending 2022 Annual Review
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Equity Learning for Health Professionals Program
May 12, 2023
MCGP
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Face-to-Face Interpreter Request Form
May 3, 2021
Branding Update Needed
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Provider Forms
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May 11, 2021
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Fact Sheet
February 24, 2021
Pending 2022 Annual Review
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Family Planning
February 3, 2021
Pending 2022 Annual Review
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For Communities
March 25, 2021
Pending 2022 Annual Review
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For Members
February 3, 2021
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March 15, 2021
Pending 2022 Annual Review
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FSR and MRR Update Attestation
April 14, 2022
Pending 2022 Annual Review
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FSR Critical Elements: Interim Monitoring Form
May 14, 2021
FSR
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Provider Forms
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General COVID-19 Information
September 25, 2023
COVID-19
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Get Care
January 29, 2021
Pending 2022 Annual Review
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Glossary of Terms
May 7, 2021
Pending 2022 Annual Review
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Grants at Work
August 11, 2023
MCGP
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Pending 2022 Annual Review
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Grievance Form
March 17, 2021
Member Forms - Find a Form
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Pending 2022 Annual Review
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Grievance Form In-Home Supportive Services (IHSS)
November 16, 2022
Pending 2022 Annual Review
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Grievance Form Medi-Cal
November 16, 2022
Pending 2022 Annual Review
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Health and Wellness
August 8, 2022
Pending 2022 Annual Review
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Health Education and Disease Management
May 11, 2021
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Health Education Programs
May 29, 2021
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Health Plans
January 19, 2021
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Health Programs Referral Form
May 29, 2021
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Provider Forms
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June 1, 2021
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Health Rewards Program
March 10, 2023
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Healthcare Technology Program
April 7, 2023
MCGP
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Pending 2022 Annual Review
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Healthy Breathing for Life Asthma Management Program
May 31, 2021
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Healthy Communities
April 13, 2021
Pending 2022 Annual Review
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Healthy Moms, Healthy Babies
August 9, 2022
Pending 2022 Annual Review
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Healthy Start
March 3, 2023
Pending 2022 Annual Review
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Pending Comms Review
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Healthy Weight for Life
August 9, 2022
Pending 2022 Annual Review
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HEDIS Code Set
May 28, 2021
HEDIS
,
Pending 2022 Annual Review
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HEDIS FAQ Guide
May 28, 2021
HEDIS
,
Pending 2022 Annual Review
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HEDIS Resources
May 21, 2021
Pending 2022 Annual Review
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Home Visiting Program
April 7, 2023
MCGP
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Pending 2022 Annual Review
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How to Apply
March 26, 2021
MCGP
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Pending 2022 Annual Review
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How to Join
January 19, 2021
Medi-Cal
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Pending 2022 Annual Review
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How to Join
January 19, 2021
IHSS
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Pending 2022 Annual Review
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How to Join
May 10, 2021
Pending 2022 Annual Review
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Immunization Resources
May 11, 2021
Brandfolder Assets
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Pending 2022 Annual Review
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Immunization Schedules and Vaccines
August 9, 2022
Pending 2022 Annual Review
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Immunizations: Adolescents Tip Sheet
April 22, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Immunizations: Adult – Exploratory Measure Tip Sheet
April 26, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Immunizations: Children (Combo 10) Tip Sheet
April 27, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Pending Comms Review
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Infection Control: Spore Testing Job Aid
May 14, 2021
Branding Update Needed
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FSR
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Pending 2022 Annual Review
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Information Release
February 16, 2021
Member Forms - Find a Form
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Pending 2022 Annual Review
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Provider Forms
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Initial Health Assessment
May 11, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Initial Health Assessment Tip Sheet
April 27, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Instructions on how to download a form
March 4, 2022
Pending 2022 Annual Review
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Insurance Information
March 12, 2021
Member Forms - Find a Form
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International Board Certified Lactation Consultants and Breast Pump Vendor List
May 31, 2021
Pending 2022 Annual Review
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Interpreter Services Provider Quick Reference Guide
May 3, 2021
Pending 2022 Annual Review
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Interpreter Services Quality Assurance Form
May 3, 2021
Branding Update Needed
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Pending 2022 Annual Review
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Provider Forms
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Introducing Medi-Cal Rx
August 17, 2021
Pending 2022 Annual Review
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job
February 2, 2021
Pending 2022 Annual Review
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Join Our Network
May 7, 2021
Pending 2022 Annual Review
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Lead Screening in Children – Exploratory Measure Tip Sheet
April 27, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Pending 2023 Annual Review
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Leadership
January 20, 2021
Pending 2022 Annual Review
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Linguistic Competence Provider Incentive
May 12, 2023
MCGP
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Pending 2022 Annual Review
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Pending Comms Review
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Linguistic Competence Provider Incentive Attestation
January 23, 2023
Pending 2022 Annual Review
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Locum Tenens Notification Form
August 18, 2022
Health Services
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Pending 2022 Annual Review
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Provider Forms
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Long Term Care Treatment Authorization Request
May 28, 2021
Branding Update Needed
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Health Services
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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MA Recruitment Program
May 12, 2023
MCGP
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Pending 2022 Annual Review
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Manage Care
April 20, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Managing Disease
April 8, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Maternity Care: Postpartum Tip Sheet
April 27, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Pending 2023 Annual Review
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Maternity Care: Prenatal Tip Sheet
April 27, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Maximizing Routine Immunization During the COVID-19 Pandemic
June 4, 2021
Pending 2022 Annual Review
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Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet
June 1, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Medi-Cal
January 19, 2021
Medi-Cal
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Pending 2022 Annual Review
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Pending Comms Review
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Medi-Cal Covered Benefits Matrix
April 28, 2021
Medi-Cal
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Pending 2022 Annual Review
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Medi-Cal Member Handbook
April 28, 2021
Medi-Cal
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Pending 2022 Annual Review
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Medi-Cal Provider-Preventable Conditions Reporting Portal
May 28, 2021
Health Services
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Pending 2022 Annual Review
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Provider Forms
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Medi-Cal Rx
August 9, 2021
Pending 2022 Annual Review
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Medical Clearance for General Anesthesia or IV Sedation for Dental Procedures
May 28, 2021
Branding Update Needed
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Health Services
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Pending 2022 Annual Review
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Provider Forms
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Medical Equipment
February 3, 2021
Pending 2022 Annual Review
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Medical Nutrition Therapy Benefit Quick Reference Guide
May 7, 2021
Branding Update Needed
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Checklist
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Pending 2022 Annual Review
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Pharmacy
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Quick Reference Guide
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May 11, 2021
Pending 2022 Annual Review
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Medication Management Agreement (MMA)
May 28, 2021
Branding Update Needed
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Health Services
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Pending 2022 Annual Review
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Pending Comms Review
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Provider Forms
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February 3, 2022
Branding Update Needed
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Health Services
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Pending 2022 Annual Review
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Pending Comms Review
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Provider Forms
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Member Grievance Form – Medi-Cal
February 3, 2022
Branding Update Needed
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Health Services
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Pending 2022 Annual Review
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Pending Comms Review
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Provider Forms
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Member ID Card
February 4, 2021
Pending 2022 Annual Review
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May 11, 2021
Pending 2022 Annual Review
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March 28, 2023
Pending 2022 Annual Review
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May 28, 2021
Branding Update Needed
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Pending 2022 Annual Review
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Provider Forms
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Provider Services
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December 29, 2021
Pending 2022 Annual Review
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Pending Comms Review
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February 11, 2021
Member Forms - Find a Form
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Pending 2022 Annual Review
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Member Services
February 5, 2021
Pending 2022 Annual Review
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Member Services Advisory Group Application
April 30, 2021
Pending 2022 Annual Review
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Mission, Vision and Values
December 14, 2020
Pending 2022 Annual Review
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New Non-PCP Training
June 3, 2021
Pending 2022 Annual Review
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New PCP Training
June 3, 2021
Pending 2022 Annual Review
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New Provider Attestation Form
July 6, 2021
Pending 2022 Annual Review
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Provider Forms
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December 14, 2021
Pending 2022 Annual Review
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Provider Forms
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May 10, 2021
Pending 2022 Annual Review
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May 14, 2021
Pending 2022 Annual Review
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Non-Physician Medical Practitioner Application
May 28, 2021
Branding Update Needed
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Pending 2022 Annual Review
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Provider Forms
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March 18, 2021
Pending 2022 Annual Review
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Notice of Privacy Practices
July 28, 2021
Pending 2022 Annual Review
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Nurse Advice Line
February 3, 2021
Pending 2022 Annual Review
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June 18, 2021
Pending 2022 Annual Review
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February 5, 2021
Pending 2022 Annual Review
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February 10, 2021
Member Forms - Find a Form
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Pending 2022 Annual Review
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Organizational Provider Application
May 28, 2021
Branding Update Needed
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Pending 2022 Annual Review
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Pending Department Review
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Provider Forms
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Other Health Coverage (OHC) Referral Form
May 28, 2021
Finance
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Other Services
February 23, 2021
Pending 2022 Annual Review
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Our Test Page
July 12, 2022
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Outpatient Clinical Laboratory Provider Application
May 28, 2021
Branding Update Needed
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Pain Management and Substance Use Resources
June 1, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Parent Education and Support Program
May 12, 2023
MCGP
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Partners for Active Living Program
April 7, 2023
MCGP
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Partners for Healthy Food Access Program
March 29, 2021
MCGP
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Pass Through/Supplemental Payments FAQ
May 28, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Patient Complaint/Grievance Tracking Log
May 28, 2021
Branding Update Needed
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Provider Services
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September 6, 2022
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Pharmacy Services
May 6, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Physical Accessibility Review Survey
May 11, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Physician Certification Statement of Medical Necessity for NEMT
May 28, 2021
Branding Update Needed
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Health Services
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Physician Orders for Life-Sustaining Treatment (POLST)
May 28, 2021
Health Services
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Plan All-Cause Readmissions Tip Sheet
April 27, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Pending 2023 Annual Review
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Pending Comms Review
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Pending Department Review
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Premiums
January 19, 2021
IHSS
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Prescription Drugs and Pharmacy Benefits
February 3, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Preventable Emergency Care Visit Diagnosis Tip Sheet
April 29, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Preventable Emergency Visits Tip Sheet
April 27, 2021
CBI
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CBI Resources
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Prevention and Self-Management Programs
June 26, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Primary Care
February 3, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Prior Authorization Criteria
May 6, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Prior Authorization Information Request for Injectable Drugs
May 6, 2021
Branding Update Needed
,
Checklist
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Pharmacy
,
Provider Forms
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Privacy Request
February 17, 2021
Member Forms - Find a Form
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Procedure Reimbursement Rate Request
May 26, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
,
Provider Forms
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Programmatic Measure Benchmarks & Performance Improvement
April 26, 2021
CBI
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CBI Resources
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Change Request (PCR)
May 28, 2021
Branding Update Needed
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Health Services
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Provider Compliance Concern Report
March 29, 2022
Branding Update Needed
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Health Services
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Provider Credentialing Applications and Policies
May 10, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Directory Information Attestation Form
May 10, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Forms
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Provider Event Submission
May 4, 2022
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Events Calendar
April 6, 2022
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Identified Overpayment Form
May 28, 2021
Branding Update Needed
,
Finance
,
Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
,
Provider Forms
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Provider Information Change Form
April 19, 2023
Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
,
Provider Forms
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Provider Inquiry Form
May 28, 2021
Branding Update Needed
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
,
Provider Forms
,
Provider Services
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Provider Manual
April 22, 2021
Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
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Provider Network Interest Form
June 14, 2023
Pending 2022 Annual Review
,
Pending Comms Review
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Pending Department Review
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Provider News
April 23, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider News Archives
March 29, 2022
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider News Posts
July 19, 2022
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Portal
March 15, 2021
Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
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Provider Portal Account Request Form – Step 2
November 3, 2022
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Provider Recruitment Program
March 29, 2021
MCGP
,
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Provider Resources
March 30, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Public Meetings
January 22, 2021
Pending 2022 Annual Review
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Pending Comms Review
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Quitting Tobacco
August 9, 2022
Pending 2022 Annual Review
,
Pending Comms Review
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Pending Department Review
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Re-Credentialing
March 23, 2023
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Regulatory Information
May 14, 2021
Pending 2022 Annual Review
,
Pending Comms Review
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Remittance Advice Explain Codes
May 28, 2021
EDI
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Remittance Advice Guide
May 28, 2021
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
,
Remittance Advice
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Request for Member Reassignment Form
May 28, 2021
Branding Update Needed
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
,
Provider Forms
,
Provider Services
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Request for Provider Information
November 21, 2022
Health Services
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Pending 2022 Annual Review
,
Pending Department Review
,
Provider Forms
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Request Personal Representative
February 12, 2021
Member Forms - Find a Form
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Pending 2022 Annual Review
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Pending Comms Review
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Pending Department Review
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Screening for Depression and Follow-Up Plan Tip Sheet
January 1, 2022
CBI
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CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Seniors and Disabilities
June 1, 2021
Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
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Social Media Code of Conduct
May 14, 2021
Pending 2022 Annual Review
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Pending Comms Review
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SortPak Brochure
May 28, 2021
COVID-19 Vaccine
,
Pending 2022 Annual Review
,
Pending Comms Review
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Stay one step ahead of COVID-19
March 21, 2022
Booster Incentive
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Staying Healthy
April 8, 2021
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Staying Healthy Assessment
May 11, 2021
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Strategic Plan 2022-2026
January 25, 2022
Pending 2022 Annual Review
,
Pending Comms Review
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Synagis Statement of Medical Necessity
May 6, 2021
Branding Update Needed
,
Checklist
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
,
Pharmacy
,
Provider Forms
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Telehealth Services
May 19, 2021
Pending 2022 Annual Review
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Pending Comms Review
,
Pending Department Review
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Tobacco Cessation Benefit Description
May 31, 2021
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Transparency in Coverage (CMS 9915) Machine Readable Files
May 17, 2022
Pending 2022 Annual Review
,
Pending Comms Review
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Transportation Provider Application
May 28, 2021
Branding Update Needed
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
,
Provider Forms
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Transportation Services Request Form
May 28, 2021
Branding Update Needed
,
Health Services
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
,
Provider Forms
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Treatment Authorization Request (TAR)
May 7, 2021
Checklist
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
,
Pharmacy
,
Provider Forms
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Tuberculosis (TB) Risk Assessment – Exploratory Measure Tip Sheet
April 27, 2021
CBI
,
CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Unhealthy Alcohol Screening and Behavioral Counseling
May 11, 2021
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet
April 27, 2021
CBI
,
CBI Resources
,
Pending 2022 Annual Review
,
Pending Comms Review
,
Pending Department Review
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