Pending 2022 Annual Review

2021 Bridge Plan

2021 PNA Report (Tri-county)

2022 PNA Report (Tri-county)

90-Day Referral Completion – Exploratory Measure Tip Sheet

A to Z Glossary of Spanish & Hmong Terms

About the Alliance

Adult Enhanced Care Management Provider Referral Form (age 21 and over)

Adult Weight Management

Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents Tip Sheet

All Plan Letters

Alliance Alternative Access Standards

Alliance Care IHSS Benefits Matrix

Alliance Care IHSS Member Handbook

Alliance Care IHSS Price Transparency Tool

Alliance Care IHSS Summary of Benefits and Coverage

Alliance Care In-Home Supportive Services (IHSS)

Alliance Holidays

Alliance Language Assistance Services

Allied Health Professional Credentialing Application

Am I Eligible?

Am I Eligible?

Ambulatory Care Sensitive Admissions Tip Sheet

Antidepressant Medication Management Tip Sheet

Application of Fluoride Varnish Tip Sheet

Approvals for Care


Asthma Education Benefit Description

Asthma Education is Available for Your Alliance Patients

Asthma Medication Ratio Tip Sheet

Asthma Self-Management Education Checklist

Authorization Status Request

Beacon Health Options Medi-Cal Provider FAQs

Beacon Health Options Screening Guidelines for Autism



Best Practices for Reducing Patient No-Shows Tip Sheet

Blood Lead Testing Flyer

Breast Cancer Screening Tip Sheet


Breastfeeding and Lactation Education Checklist

Breastfeeding Support and Breast Pump Benefit

Breastfeeding Support and Breast Pump Benefit Clinical Health Education Benefit

California Advance Health Care Directive Form

California Participating Practitioner Application

Capital Program

Care Management

Care Management Referral Form

Care-Based Incentive

Care-Based Incentive (CBI) Summary

Carelon Care Management Referral Form

Carelon Diagnostic Evaluation Form (Medi-Cal)

Carelon Primary Care Provider (PCP) Referral Form

CBI Technical Specifications

Central California Alliance for Health

Certification Regarding Debarment Suspension, Ineligibility and Voluntary Exclusion

Certification Regarding Lobbying – Exhibit D(F) Att 1 and 2

Cervical Cancer Screening Tip Sheet

Changes to Public Charge


Child and Adolescent Well-Care Visits Tip Sheet

Child and Adolescents BMI Assessment Tip Sheet

Chlamydia Screening in Women – Exploratory Measure Tip Sheet

Choose Primary Doctor

Chronic Conditions

CHW Recruitment Program

Clinical Resources

Colorectal Cancer Screening – Exploratory Measure Tip Sheet

Community Based Adult Services (CBAS) Inquiry Form

Community Events

Community Health Champions

Community Impact Reports

Community Publications

Community Resources

Community Supports

Community Supports (CS) Provider Information

Community Supports: Environmental Accessibility and Adaptability (EAA) Provider Referral Form

Community Supports: Housing Provider Referral Form

Community Supports: Meals Provider Referral Form

Community Supports: Personal Care and Home Maker Services and Respite Services for Caregivers Provider Referral

Complex Case Management and Care Coordination

Confidential Communications Request Form

Consent for Sterilization or Hysterectomy Sample Form

Contact Us

Controlling High Blood Pressure – Exploratory Measure Tip Sheet

Corrected Claim Submission Form

COVID-19 Information

COVID-19 Testing and Treatment

COVID-19 Vaccine Administration for Providers

COVID-19 Vaccine Information

COVID-19 Vaccine Information for Medi-Cal Members

COVID-19 Vaccine Information for Medi-Cal Members Flyer

COVID-19 Vaccine Information Videos

COVID-19: Information for Providers

Credit Balance Report

Crush COVID!

Cultural and Linguistic Services

Data Sharing Incentive

Dental and Vision

Depression Screening for Adolescents and Adults Tip Sheet

Depression Tool Kit

Developer Application

Developer Questionnaire

Developer Resources

Developmental Screening in the First 3 Years Tip Sheet

DHCS Facility Site Review (FSR) Checklist

DHCS Medical Record Review (MRR) Checklist

DHCS Vaccine Recommendations During COVID-19

Diabetes Eye Exam Services Resource List – English

Diabetes Eye Exam Services Resource List – Hmong

Diabetes Eye Exam Services Resource List – Spanish

Diabetes Self-Management Education Benefit Description


Diabetic HbA1c Poor Control >9% Tip Sheet

Disease Management Programs

Doula Provider Application

Drug Recalls and Withdrawals

Durable Medical Equipment Provider Application

EDI Claims Enrollment Form

EDI Claims Enrollment Form Instructions

EDI Companion Guide – 270/271 Information

EDI Companion Guide – 276/277 Information

EDI Companion Guide – 837/835 Trading Partner Information

EDI Companion Guide – Transaction Instruction

Enhanced Care Management (ECM)

Enhanced Care Management (ECM) and Community Supports Provider FAQs

Enhanced Care Management (ECM) and Community Supports Provider Information

Enhanced Care Management (ECM) and Community Supports Provider Referrals

Enhanced Care Management (ECM) and Community Supports Trainings

Enhanced Care Management (ECM) Provider Information

Enhanced Care Management and Community Supports for Members

Equity Learning for Health Professionals Program

Face-to-Face Interpreter Request Form

Facility Site Review

Fact Sheet

Family Planning

For Communities

For Members

For Providers

FSR and MRR Update Attestation

FSR Critical Elements: Interim Monitoring Form

Funding Opportunities

General COVID-19 Information

Get Care

Glossary of Terms

Grants at Work

Grievance Form

Grievance Form In-Home Supportive Services (IHSS)

Grievance Form Medi-Cal

Health and Wellness

Health Education and Disease Management

Health Education Programs

Health Plans

Health Programs Referral Form

Health Resources

Health Rewards Program

Healthcare Technology Program

Healthy Breathing for Life Asthma Management Program

Healthy Communities

Healthy Moms, Healthy Babies

Healthy Start

Healthy Weight for Life

HEDIS Code Set


HEDIS Resources

Home Visiting Program

How to Apply

How to Join

How to Join

How to Join

Immunization Resources

Immunization Schedules and Vaccines

Immunizations: Adolescents Tip Sheet

Immunizations: Adult – Exploratory Measure Tip Sheet

Immunizations: Children (Combo 10) Tip Sheet

Infant Wellness Map

Infection Control: Spore Testing Job Aid

Information Release

Initial Health Appointment Tip Sheet

Initial Health Assessment

Instructions on how to download a form

Insurance Information

International Board Certified Lactation Consultants and Breast Pump Vendor List

Interpreter Services Provider Quick Reference Guide

Interpreter Services Quality Assurance Form

Introducing Medi-Cal Rx


Join Our Network

Lead Screening in Children Tip Sheet


Linguistic Competence Provider Incentive

Linguistic Competence Provider Incentive Attestation

Locum Tenens Notification Form

Long Term Care Treatment Authorization Request

MA Recruitment Program

Manage Care

Managing Disease

Maternity Care: Postpartum Tip Sheet

Maternity Care: Prenatal Tip Sheet

Maximizing Routine Immunization During the COVID-19 Pandemic

Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet


Medi-Cal Covered Benefits Matrix

Medi-Cal Member Handbook

Medi-Cal Provider-Preventable Conditions Reporting Portal

Medi-Cal Rx

Medical Clearance for General Anesthesia or IV Sedation for Dental Procedures

Medical Equipment

Medical Nutrition Therapy Benefit Quick Reference Guide

Medical Record Review

Medication Management Agreement (MMA)

Member Grievance Form – IHSS

Member Grievance Form – Medi-Cal

Member ID Card

Member Incentives

Member News

Member Notice Letters

Member Online Account

Member Reimbursement Claim Form

Member Services

Member Services Advisory Group Application

Mission, Vision and Values

New Non-PCP Training

New PCP Training

New Provider Attestation Form

New Provider ECM/Community Supports Training Sign Off Form

New Provider Orientation


Non-Physician Medical Practitioner Application

Nondiscrimination Policy

Notice of Privacy Practices

Nurse Advice Line

Online Provider Directory Tutorial

Online Self-Service

Order ID Card, Member Handbook and Provider Directory

Organizational Provider Application

Other Health Coverage (OHC) Referral Form

Other Services

Our Test Page

Outpatient Clinical Laboratory Provider Application

Pain Management and Substance Use Resources

Parent Education and Support Program

Partners for Active Living Program

Partners for Healthy Food Access Program

Pass Through/Supplemental Payments FAQ

Patient Complaint/Grievance Tracking Log

Pharmacy Forms

Pharmacy Services

Physical Accessibility Review Survey

Physician Certification Statement of Medical Necessity for NEMT

Physician Orders for Life-Sustaining Treatment (POLST)

Plan All-Cause Readmissions Tip Sheet


Prescription Drugs and Pharmacy Benefits

Preventable Emergency Care Visit Diagnosis Tip Sheet

Preventable Emergency Visits Tip Sheet

Prevention and Self-Management Programs

Primary Care

Prior Authorization Criteria

Prior Authorization Information Request for Injectable Drugs

Privacy Request

Procedure Reimbursement Rate Request

Programmatic Measure Benchmarks & Performance Improvement

Provider Change Request (PCR)

Provider Credentialing Applications and Policies

Provider Directory Information Attestation Form

Provider Event Submission

Provider Events Calendar

Provider Identified Overpayment Form

Provider Information Change Form

Provider Inquiry Form

Provider Manual

Provider Network Interest Form

Provider News

Provider News Archives

Provider News Posts

Provider Portal

Provider Portal Account Request Form – Step 2

Provider Recruitment Program

Provider Resources

Public Meetings

Quitting Tobacco


Regulatory Information

Remittance Advice Explain Codes

Remittance Advice Guide

Request for Administrative Member Status

Request for Member Reassignment Form

Request for Provider Information

Request Personal Representative

Seniors and Disabilities

Social Determinates of Health, Diagnosis Accuracy, and CPT II Coding Tip Sheet

Social Media Code of Conduct

SortPak Brochure

Stay one step ahead of COVID-19

Staying Healthy

Staying Healthy Assessment

Strategic Plan 2022-2026

Synagis Statement of Medical Necessity

Telehealth Services

The Alliance’s Texting Terms and Conditions