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Pending Department Review

Request for Administrative Member Status

March 28, 2024
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Data Sharing Incentive

March 2, 2024
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Enhanced Care Management (ECM) and Community Supports Provider FAQs

February 16, 2024
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Infant Wellness Map

February 8, 2024
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Update Other Health Insurance

February 5, 2024
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The Alliance’s Texting Terms and Conditions

February 2, 2024
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Hyaluronic Acid Derivatives Prior Authorization Information Request

January 11, 2024
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Potential Compliance Concern Report

December 29, 2023
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Well-Child Visits for Age 15-30 Months of Life – Exploratory Measure Tip Sheet

December 28, 2023
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Social Determinates of Health, Diagnosis Accuracy, and CPT II Coding Tip Sheet

December 27, 2023
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Urgent Visit Access Initiative San Benito County

December 22, 2023
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Urgent Visit Access Initiative Mariposa County

December 22, 2023
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Doula Recruitment Program

November 20, 2023
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Non-Emergency Medical Transportation Minor Consent Form

October 13, 2023
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COVID-19 Testing and Treatment

September 25, 2023
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General COVID-19 Information

September 25, 2023
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COVID-19 Vaccine Information

September 25, 2023
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Carelon Primary Care Provider (PCP) Referral Form

September 19, 2023
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Community Supports (CS) Provider Information

August 23, 2023
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Enhanced Care Management (ECM) Provider Information

August 23, 2023
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Enhanced Care Management (ECM) and Community Supports Provider Referrals

August 23, 2023
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Enhanced Care Management and Community Supports for Members

August 18, 2023
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Enhanced Care Management (ECM) and Community Supports Provider Information

August 15, 2023
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Grants at Work

August 11, 2023
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Enhanced Care Management (ECM) and Community Supports Trainings

August 11, 2023
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Doula Provider Application

August 3, 2023
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Doula Services Benefit

August 3, 2023
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Community Supports: Member Personal Care and Homemaker Services and Respite Services Referral Form

July 7, 2023
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Youth Enhanced Care Management Member Referral Form (age 20 and under)

July 7, 2023
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Community Supports: Personal Care and Home Maker Services and Respite Services for Caregivers Provider Referral

July 7, 2023
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Youth Enhanced Care Management Provider Referral Form (age 20 and under)

July 7, 2023
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Community Health Worker Benefit

June 23, 2023
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Provider Network Interest Form

June 14, 2023
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All Plan Letters

May 24, 2023
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Parent Education and Support Program

May 12, 2023
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Community Health Champions

May 12, 2023
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Equity Learning for Health Professionals Program

May 12, 2023
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Linguistic Competence Provider Incentive

May 12, 2023
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Workforce Recruitment Programs

May 12, 2023
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MA Recruitment Program

May 12, 2023
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Provider Information Change Form

April 19, 2023
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Healthcare Technology Program

April 7, 2023
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Home Visiting Program

April 7, 2023
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Partners for Active Living Program

April 7, 2023
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CHW Recruitment Program

April 7, 2023
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Member News

March 28, 2023
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Re-Credentialing

March 23, 2023
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Adult Enhanced Care Management Member Referral Form (age 21 and over)

March 13, 2023
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Community Supports: Meals Member Referral Form

March 13, 2023
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Community Supports: Member Housing Referral Form

March 13, 2023
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Community Supports: Environmental Accessibility and Adaptability (EAA) Member Referral Form

March 13, 2023
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Health Rewards Program

March 10, 2023
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Healthy Start

March 3, 2023
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Medi-Cal Renewal

March 1, 2023
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Linguistic Competence Provider Incentive Attestation

January 23, 2023
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Renew your Medi-Cal

January 4, 2023
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Enhanced Care Management and Community Supports

December 27, 2022
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Community Supports: Environmental Accessibility and Adaptability (EAA) Provider Referral Form

December 22, 2022
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Community Supports: Meals Provider Referral Form

December 22, 2022
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Community Supports

December 15, 2022
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Enhanced Care Management (ECM)

December 15, 2022
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Colorectal Cancer Screening – Exploratory Measure Tip Sheet

December 14, 2022
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EDI Claims Enrollment Form

December 8, 2022
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Alliance Care IHSS Price Transparency Tool

December 5, 2022
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Changes to Public Charge

November 22, 2022
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Request for Provider Information

November 21, 2022
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Grievance Form In-Home Supportive Services (IHSS)

November 16, 2022
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Grievance Form Medi-Cal

November 16, 2022
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Provider Portal Account Request Form – Step 2

November 3, 2022
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Community Events

September 28, 2022
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Pharmacy Forms

September 6, 2022
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Locum Tenens Notification Form

August 18, 2022
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Webinars Archive List

August 9, 2022
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Quitting Tobacco

August 9, 2022
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Wellness that Works

August 9, 2022
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Healthy Weight for Life

August 9, 2022
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Healthy Moms, Healthy Babies

August 9, 2022
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Breastfeeding

August 9, 2022
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Chronic Conditions

August 9, 2022
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Diabetes/Prediabetes

August 9, 2022
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Asthma

August 9, 2022
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Checkups

August 9, 2022
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Immunization Schedules and Vaccines

August 9, 2022
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Health and Wellness

August 8, 2022
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Provider News Posts

July 19, 2022
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Our Test Page

July 12, 2022
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2022 PNA Report (Tri-county)

July 11, 2022
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Confidential Communications Request Form

June 22, 2022
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Provider Event Submission

May 4, 2022
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FSR and MRR Update Attestation

April 14, 2022
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Provider Events Calendar

April 6, 2022
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Provider News Archives

March 29, 2022
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Stay one step ahead of COVID-19

March 21, 2022
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Instructions on how to download a form

March 4, 2022
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Community Publications

February 24, 2022
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2021 PNA Report (Tri-county)

February 16, 2022
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Community Impact Reports

February 16, 2022
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Member Grievance Form – IHSS

February 3, 2022
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Member Grievance Form – Medi-Cal

February 3, 2022
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Adult Enhanced Care Management Provider Referral Form (age 21 and over)

January 4, 2022
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Community Supports: Housing Provider Referral Form

January 4, 2022
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Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents Tip Sheet

January 1, 2022
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Depression Screening for Adolescents and Adults Tip Sheet

January 1, 2022
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Member Online Account

December 29, 2021
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New Provider ECM/Community Supports Training Sign Off Form

December 14, 2021
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Crush COVID!

October 7, 2021
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Procedure Code Lookup Tool (PCL)

October 5, 2021
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Introducing Medi-Cal Rx

August 17, 2021
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Website Feedback

August 10, 2021
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Medi-Cal Rx

August 9, 2021
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Notice of Privacy Practices

July 28, 2021
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New Provider Attestation Form

July 6, 2021
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Asthma Education is Available for Your Alliance Patients

June 26, 2021
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Prevention and Self-Management Programs

June 26, 2021
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Diabetes Eye Exam Services Resource List – Hmong

June 25, 2021
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Diabetes Eye Exam Services Resource List – Spanish

June 25, 2021
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Diabetes Eye Exam Services Resource List – English

June 25, 2021
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COVID-19 Vaccine Information Videos

June 22, 2021
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COVID-19: Information for Providers

June 18, 2021
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Online Provider Directory Tutorial

June 18, 2021
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Asthma Education Benefit Description

June 14, 2021
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Carelon Care Management Referral Form

June 13, 2021
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Carelon Diagnostic Evaluation Form (Medi-Cal)

June 13, 2021
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Maximizing Routine Immunization During the COVID-19 Pandemic

June 4, 2021
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New Non-PCP Training

June 3, 2021
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New PCP Training

June 3, 2021
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Beacon Health Options Screening Guidelines for Autism

June 1, 2021
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Beacon Health Options Medi-Cal Provider FAQs

June 1, 2021
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Breastfeeding Support and Breast Pump Benefit

June 1, 2021
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Maximizing Your Value-Based Payments using CPT Category II Coding Tip Sheet

June 1, 2021
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Health Resources

June 1, 2021
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Seniors and Disabilities

June 1, 2021
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Pain Management and Substance Use Resources

June 1, 2021
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Complex Case Management and Care Coordination

June 1, 2021
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Tobacco Cessation Benefit Description

May 31, 2021
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International Board Certified Lactation Consultants and Breast Pump Vendor List

May 31, 2021
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Breastfeeding Support and Breast Pump Benefit Clinical Health Education Benefit

May 31, 2021
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Healthy Breathing for Life Asthma Management Program

May 31, 2021
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Breastfeeding and Lactation Education Checklist

May 29, 2021
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Asthma Self-Management Education Checklist

May 29, 2021
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Diabetes Self-Management Education Benefit Description

May 29, 2021
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Health Programs Referral Form

May 29, 2021
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Disease Management Programs

May 29, 2021
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Health Education Programs

May 29, 2021
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Member Notice Letters

May 28, 2021
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Request for Member Reassignment Form

May 28, 2021
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Provider Inquiry Form

May 28, 2021
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Transportation Provider Application

May 28, 2021
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Outpatient Clinical Laboratory Provider Application

May 28, 2021
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Durable Medical Equipment Provider Application

May 28, 2021
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Organizational Provider Application

May 28, 2021
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Allied Health Professional Credentialing Application

May 28, 2021
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Non-Physician Medical Practitioner Application

May 28, 2021
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California Participating Practitioner Application

May 28, 2021
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COVID-19 Information

May 28, 2021
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Patient Complaint/Grievance Tracking Log

May 28, 2021
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Certification Regarding Lobbying – Exhibit D(F) Att 1 and 2

May 28, 2021
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Certification Regarding Debarment Suspension, Ineligibility and Voluntary Exclusion

May 28, 2021
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Transportation Services Request Form

May 28, 2021
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Physician Certification Statement of Medical Necessity for NEMT

May 28, 2021
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Physician Orders for Life-Sustaining Treatment (POLST)

May 28, 2021
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Medication Management Agreement (MMA)

May 28, 2021
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Medical Clearance for General Anesthesia or IV Sedation for Dental Procedures

May 28, 2021
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Medi-Cal Provider-Preventable Conditions Reporting Portal

May 28, 2021
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Consent for Sterilization or Hysterectomy Sample Form

May 28, 2021
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Community Based Adult Services (CBAS) Inquiry Form

May 28, 2021
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Long Term Care Treatment Authorization Request

May 28, 2021
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Authorization Status Request

May 28, 2021
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Provider Change Request (PCR)

May 28, 2021
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Care Management Referral Form

May 28, 2021
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California Advance Health Care Directive Form

May 28, 2021
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Other Health Coverage (OHC) Referral Form

May 28, 2021
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Provider Identified Overpayment Form

May 28, 2021
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Credit Balance Report

May 28, 2021
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Corrected Claim Submission Form

May 28, 2021
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Pass Through/Supplemental Payments FAQ

May 28, 2021
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Remittance Advice Explain Codes

May 28, 2021
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Remittance Advice Guide

May 28, 2021
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EDI Companion Guide – 270/271 Information

May 28, 2021
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EDI Companion Guide – 276/277 Information

May 28, 2021
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EDI Companion Guide – 837/835 Trading Partner Information

May 28, 2021
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EDI Companion Guide – Transaction Instruction

May 28, 2021
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EDI Claims Enrollment Form Instructions

May 28, 2021
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HEDIS Code Set

May 28, 2021
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HEDIS FAQ Guide

May 28, 2021
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Procedure Reimbursement Rate Request

May 26, 2021
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HEDIS Resources

May 21, 2021
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Telehealth Services

May 19, 2021
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DHCS Medical Record Review (MRR) Checklist

May 14, 2021
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Infection Control: Spore Testing Job Aid

May 14, 2021
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DHCS Facility Site Review (FSR) Checklist

May 14, 2021
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FSR Critical Elements: Interim Monitoring Form

May 14, 2021
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DHCS Vaccine Recommendations During COVID-19

May 13, 2021
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COVID-19 Vaccine Administration for Providers

May 12, 2021
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Care Management

May 11, 2021
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Physical Accessibility Review Survey

May 11, 2021
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Medical Record Review

May 11, 2021
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Facility Site Review

May 11, 2021
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Unhealthy Alcohol Screening and Behavioral Counseling

May 11, 2021
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Staying Healthy Assessment

May 11, 2021
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Initial Health Assessment

May 11, 2021
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Member Incentives

May 11, 2021
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Immunization Resources

May 11, 2021
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HEDIS

May 11, 2021
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Health Education and Disease Management

May 11, 2021
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Provider Directory Information Attestation Form

May 10, 2021
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Timely Access to Care

May 10, 2021
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New Provider Orientation

May 10, 2021
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Provider Credentialing Applications and Policies

May 10, 2021
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How to Join

May 10, 2021
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Why Join

May 10, 2021
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Clinical Resources

May 7, 2021
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Join Our Network

May 7, 2021
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Glossary of Terms

May 7, 2021
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Medical Nutrition Therapy Benefit Quick Reference Guide

May 7, 2021
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Treatment Authorization Request (TAR)

May 7, 2021
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Prior Authorization Information Request for Injectable Drugs

May 6, 2021
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Synagis Statement of Medical Necessity

May 6, 2021
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Provider Portal Account Request Form

May 6, 2021
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Prior Authorization Criteria

May 6, 2021
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Prescription Drug Prior Authorization or Step Therapy Exception Request Form

May 6, 2021
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Pharmacy Formulary

May 6, 2021
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Pharmacy Services

May 6, 2021
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Alliance Care IHSS Summary of Benefits and Coverage

May 5, 2021
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Alliance Care IHSS Benefits Matrix

May 5, 2021
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Alliance Care IHSS Member Handbook

May 5, 2021
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COVID-19 Vaccine Information for Medi-Cal Members

May 4, 2021
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A to Z Glossary of Spanish & Hmong Terms

May 4, 2021
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Interpreter Services Quality Assurance Form

May 3, 2021
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Interpreter Services Provider Quick Reference Guide

May 3, 2021
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Face-to-Face Interpreter Request Form

May 3, 2021
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Cultural and Linguistic Services

May 3, 2021
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Member Services Advisory Group Application

April 30, 2021
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Blood Lead Testing Flyer

April 30, 2021
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Depression Tool Kit

April 29, 2021
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USPSTF Recommendations for Primary Care Practice

April 29, 2021
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Preventable Emergency Care Visit Diagnosis Tip Sheet

April 29, 2021
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Medi-Cal Covered Benefits Matrix

April 28, 2021
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Medi-Cal Member Handbook

April 28, 2021
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Alliance Alternative Access Standards

April 28, 2021
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Best Practices for Reducing Patient No-Shows Tip Sheet

April 27, 2021
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Ambulatory Care Sensitive Admissions Tip Sheet

April 27, 2021
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Well-Child Visits in the First 15 Months of Life Tip Sheet

April 27, 2021
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Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet

April 27, 2021
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Tuberculosis (TB) Risk Assessment – Exploratory Measure Tip Sheet

April 27, 2021
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Preventable Emergency Visits Tip Sheet

April 27, 2021
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Maternity Care: Prenatal Tip Sheet

April 27, 2021
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Maternity Care: Postpartum Tip Sheet

April 27, 2021
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Plan All-Cause Readmissions Tip Sheet

April 27, 2021
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Lead Screening in Children Tip Sheet

April 27, 2021
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Initial Health Appointment Tip Sheet

April 27, 2021
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Diabetic HbA1c Poor Control >9% Tip Sheet

April 27, 2021
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Developmental Screening in the First 3 Years Tip Sheet

April 27, 2021
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Controlling High Blood Pressure – Exploratory Measure Tip Sheet

April 27, 2021
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Immunizations: Children (Combo 10) Tip Sheet

April 27, 2021
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Chlamydia Screening in Women – Exploratory Measure Tip Sheet

April 27, 2021
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Child and Adolescent Well-Care Visits Tip Sheet

April 27, 2021
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Cervical Cancer Screening Tip Sheet

April 27, 2021
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Child and Adolescents BMI Assessment Tip Sheet

April 27, 2021
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Breast Cancer Screening Tip Sheet

April 27, 2021
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Application of Fluoride Varnish Tip Sheet

April 26, 2021
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Asthma Medication Ratio Tip Sheet

April 26, 2021
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Antidepressant Medication Management Tip Sheet

April 26, 2021
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Immunizations: Adult – Exploratory Measure Tip Sheet

April 26, 2021
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Programmatic Measure Benchmarks & Performance Improvement

April 26, 2021
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Provider Portal User Guide

April 26, 2021
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Provider Portal Quick Reference

April 26, 2021
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Provider Portal Frequently Asked Questions

April 26, 2021
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What’s New for the Care-Based Incentive Program

April 26, 2021
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CBI Technical Specifications

April 23, 2021
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90-Day Referral Completion – Exploratory Measure Tip Sheet

April 23, 2021
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Provider News

April 23, 2021
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Provider Manual

April 22, 2021
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Provider Directory

April 22, 2021
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Immunizations: Adolescents Tip Sheet

April 22, 2021
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Care-Based Incentive (CBI) Summary

April 20, 2021
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Care-Based Incentive Resources

April 20, 2021
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Care-Based Incentive

April 20, 2021
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Quality of Care

April 20, 2021
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Manage Care

April 20, 2021
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Community Resources

April 13, 2021
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Healthy Communities

April 13, 2021
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Staying Healthy

April 8, 2021
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Managing Disease

April 8, 2021
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Whole Child Model Family Advisory Committee (WCMFAC)

March 31, 2021
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Webinars and Training

March 30, 2021
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Provider Resources

March 30, 2021
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Capital Program

March 29, 2021
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Partners for Healthy Food Access Program

March 29, 2021
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Provider Recruitment Program

March 29, 2021
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How to Apply

March 26, 2021
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For Communities

March 25, 2021
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Urgent Visit Access Initiative Merced County

March 24, 2021
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Urgent Visit Access Initiative Santa Cruz County

March 24, 2021
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Whole Child Model Family Advisory Committee Application Form

March 19, 2021
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Nondiscrimination Policy

March 18, 2021
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Grievance Form

March 17, 2021
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Using the Provider Portal

March 15, 2021
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For Providers

March 15, 2021
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Provider Portal

March 15, 2021
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