Pending Department Review

Copy of Infant Wellness Map

Important Medi-Cal Plan Information

Other Funding Opportunities in the Medi-Cal Delivery System

Drug Recalls and Withdrawals

Request for Administrative Member Status

Data Sharing Incentive

Enhanced Care Management (ECM) and Community Supports Provider FAQs

Infant Wellness Map

Update Other Health Insurance

The Alliance’s Texting Terms and Conditions

Hyaluronic Acid Derivatives Prior Authorization Information Request

Potential Compliance Concern Report

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

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

Urgent Visit Access Initiative San Benito County

Urgent Visit Access Initiative Mariposa County

Doula Recruitment Program

Non-Emergency Medical Transportation Minor Consent Form

COVID-19 Testing and Treatment

General COVID-19 Information

COVID-19 Vaccine Information

Carelon Primary Care Provider (PCP) Referral Form

Community Supports (CS) Provider Information

Enhanced Care Management (ECM) Provider Information

Enhanced Care Management (ECM) and Community Supports Provider Referrals

Enhanced Care Management and Community Supports for Members

Enhanced Care Management (ECM) and Community Supports Provider Information

Grants at Work

Enhanced Care Management (ECM) and Community Supports Trainings

Doula Provider Application

Doula Services Benefit

Community Supports: Member Personal Care and Homemaker Services and Respite Services Referral Form

Youth Enhanced Care Management Member Referral Form (age 20 and under)

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

Youth Enhanced Care Management Provider Referral Form (age 20 and under)

Community Health Worker Benefit

Provider Network Interest Form

All Plan Letters

Parent Education and Support Program

Community Health Champions

Equity Learning for Health Professionals Program

Linguistic Competence Provider Incentive

Workforce Recruitment Programs

MA Recruitment Program

Provider Information Change Form

Healthcare Technology Program

Home Visiting Program

Partners for Active Living Program

CHW Recruitment Program

Member News


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

Community Supports: Meals Member Referral Form

Community Supports: Member Housing Referral Form

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

Health Rewards Program

Healthy Start

Medi-Cal Renewal

Linguistic Competence Provider Incentive Attestation

Renew your Medi-Cal

Enhanced Care Management and Community Supports

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

Community Supports: Meals Provider Referral Form

Community Supports

Enhanced Care Management (ECM)

Colorectal Cancer Screening – Exploratory Measure Tip Sheet

EDI Claims Enrollment Form

Alliance Care IHSS Price Transparency Tool

Changes to Public Charge

Request for Provider Information

Grievance Form In-Home Supportive Services (IHSS)

Grievance Form Medi-Cal

Provider Portal Account Request Form – Step 2

Community Events

Pharmacy Forms

Locum Tenens Notification Form

Webinars Archive List

Quitting Tobacco

Adult Weight Management

Healthy Weight for Life

Healthy Moms, Healthy Babies


Chronic Conditions




Immunization Schedules and Vaccines

Health and Wellness

Provider News Posts

Our Test Page

2022 PNA Report (Tri-county)

Confidential Communications Request Form

Provider Event Submission

FSR and MRR Update Attestation

Provider Events Calendar

Provider News Archives

Stay one step ahead of COVID-19

Instructions on how to download a form

Community Publications

2021 PNA Report (Tri-county)

Community Impact Reports

Member Grievance Form – IHSS

Member Grievance Form – Medi-Cal

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

Community Supports: Housing Provider Referral Form

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

Depression Screening for Adolescents and Adults Tip Sheet

Member Online Account

New Provider ECM/Community Supports Training Sign Off Form

Crush COVID!

Procedure Code Lookup Tool (PCL)

Introducing Medi-Cal Rx

Website Feedback

Medi-Cal Rx

Notice of Privacy Practices

New Provider Attestation Form

Asthma Education is Available for Your Alliance Patients

Prevention and Self-Management Programs

Diabetes Eye Exam Services Resource List – Hmong

Diabetes Eye Exam Services Resource List – Spanish

Diabetes Eye Exam Services Resource List – English

COVID-19 Vaccine Information Videos

COVID-19: Information for Providers

Online Provider Directory Tutorial

Asthma Education Benefit Description

Carelon Care Management Referral Form

Carelon Diagnostic Evaluation Form (Medi-Cal)

Maximizing Routine Immunization During the COVID-19 Pandemic

New Non-PCP Training

New PCP Training

Beacon Health Options Screening Guidelines for Autism

Beacon Health Options Medi-Cal Provider FAQs

Breastfeeding Support and Breast Pump Benefit

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

Health Resources

Seniors and Disabilities

Pain Management and Substance Use Resources

Complex Case Management and Care Coordination

Tobacco Cessation Benefit Description

International Board Certified Lactation Consultants and Breast Pump Vendor List

Breastfeeding Support and Breast Pump Benefit Clinical Health Education Benefit

Healthy Breathing for Life Asthma Management Program

Breastfeeding and Lactation Education Checklist

Asthma Self-Management Education Checklist

Diabetes Self-Management Education Benefit Description

Health Programs Referral Form

Disease Management Programs

Health Education Programs

Member Notice Letters

Request for Member Reassignment Form

Provider Inquiry Form

Transportation Provider Application

Outpatient Clinical Laboratory Provider Application

Durable Medical Equipment Provider Application

Organizational Provider Application

Allied Health Professional Credentialing Application

Non-Physician Medical Practitioner Application

California Participating Practitioner Application

COVID-19 Information

Patient Complaint/Grievance Tracking Log

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

Certification Regarding Debarment Suspension, Ineligibility and Voluntary Exclusion

Transportation Services Request Form

Physician Certification Statement of Medical Necessity for NEMT

Physician Orders for Life-Sustaining Treatment (POLST)

Medication Management Agreement (MMA)

Medical Clearance for General Anesthesia or IV Sedation for Dental Procedures

Medi-Cal Provider-Preventable Conditions Reporting Portal

Consent for Sterilization or Hysterectomy Sample Form

Community Based Adult Services (CBAS) Inquiry Form

Long Term Care Treatment Authorization Request

Authorization Status Request

Provider Change Request (PCR)

Care Management Referral Form

California Advance Health Care Directive Form

Other Health Coverage (OHC) Referral Form

Provider Identified Overpayment Form

Credit Balance Report

Corrected Claim Submission Form

Pass Through/Supplemental Payments FAQ

Remittance Advice Explain Codes

Remittance Advice Guide

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

EDI Claims Enrollment Form Instructions

HEDIS Code Set


Procedure Reimbursement Rate Request

HEDIS Resources

Telehealth Services

DHCS Medical Record Review (MRR) Checklist

Infection Control: Spore Testing Job Aid

DHCS Facility Site Review (FSR) Checklist

FSR Critical Elements: Interim Monitoring Form

DHCS Vaccine Recommendations During COVID-19

COVID-19 Vaccine Administration for Providers

Care Management

Physical Accessibility Review Survey

Medical Record Review

Facility Site Review

Unhealthy Alcohol Screening and Behavioral Counseling

Staying Healthy Assessment

Initial Health Assessment

Member Incentives

Immunization Resources


Health Education and Disease Management

Provider Directory Information Attestation Form

Timely Access to Care

New Provider Orientation

Provider Credentialing Applications and Policies

How to Join

Why Join

Clinical Resources

Join Our Network

Glossary of Terms

Medical Nutrition Therapy Benefit Quick Reference Guide

Treatment Authorization Request (TAR)

Prior Authorization Information Request for Injectable Drugs

Synagis Statement of Medical Necessity

Provider Portal Account Request Form

Prior Authorization Criteria

Prescription Drug Prior Authorization or Step Therapy Exception Request Form

Pharmacy Formulary

Pharmacy Services

Alliance Care IHSS Summary of Benefits and Coverage

Alliance Care IHSS Benefits Matrix

Alliance Care IHSS Member Handbook

COVID-19 Vaccine Information for Medi-Cal Members

A to Z Glossary of Spanish & Hmong Terms

Interpreter Services Quality Assurance Form

Interpreter Services Provider Quick Reference Guide

Face-to-Face Interpreter Request Form

Cultural and Linguistic Services

Member Services Advisory Group Application

Blood Lead Testing Flyer

Depression Tool Kit

USPSTF Recommendations for Primary Care Practice

Preventable Emergency Care Visit Diagnosis Tip Sheet

Medi-Cal Covered Benefits Matrix

Medi-Cal Member Handbook

Alliance Alternative Access Standards

Best Practices for Reducing Patient No-Shows Tip Sheet

Ambulatory Care Sensitive Admissions 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 Measure Tip Sheet

Preventable Emergency Visits Tip Sheet

Maternity Care: Prenatal Tip Sheet

Maternity Care: Postpartum Tip Sheet

Plan All-Cause Readmissions Tip Sheet

Lead Screening in Children Tip Sheet

Initial Health Appointment 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

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

Application of Fluoride Varnish Tip Sheet

Asthma Medication Ratio Tip Sheet

Antidepressant Medication Management Tip Sheet

Immunizations: Adult – Exploratory Measure Tip Sheet

Programmatic Measure Benchmarks & Performance Improvement

Provider Portal User Guide

Provider Portal Quick Reference

Provider Portal Frequently Asked Questions

What’s New for the Care-Based Incentive Program

CBI Technical Specifications

90-Day Referral Completion – Exploratory Measure Tip Sheet

Provider News

Provider Manual

Provider Directory

Immunizations: Adolescents Tip Sheet

Care-Based Incentive (CBI) Summary

Care-Based Incentive Resources

Care-Based Incentive

Quality of Care

Manage Care

Community Resources

Healthy Communities

Staying Healthy

Managing Disease

Whole Child Model Family Advisory Committee (WCMFAC)

Webinars and Training

Provider Resources

Capital Program

Partners for Healthy Food Access Program

Provider Recruitment Program

How to Apply

For Communities

Funding Opportunities

Urgent Visit Access Initiative Merced County

Urgent Visit Access Initiative Santa Cruz County

Whole Child Model Family Advisory Committee Application Form