Alliance celebrates 30 years
Ngayong taon, ipinagdiriwang ng Alliance ang ika-30 taon ng paglilingkod sa ating mga lokal na komunidad. Thank you for making our work possible through a shared commitment to healthy people, healthy communities. We started serving Santa Cruz County in 1996. Over the years, we’ve expanded to include Mariposa, Merced, Monterey and San Benito counties. We now serve over 434,000 members with a network of over 14,000 contracted providers. Noong 2025, nakamit namin ang buong Health Plan at Health Equity Accreditation mula sa National Committee for Quality Assurance.
We’ve been proud to be a trusted ally for our members across three decades, striving to understand our communities’ unique needs and offer compassionate and culturally appropriate care for all stages of life and health conditions. This work would not be possible without strong partnerships with providers like you! Thank you for being a part of our provider network as we build this legacy together.
We have risen to meet the needs presented by an ever-changing health care landscape, from adapting to the challenges of the COVID-19 pandemic to maximizing member retention amidst upcoming changes to Medicaid.
Innovation-driven initiatives in recent years have included:
- Community health worker at doula benefits.
- Bringing our behavioral health care services in house for a more seamless member experience.
- Launching our TotalCare (HMO D-SNP) plan.
We remain committed to our mission to provide accessible, quality health care and look forward to continuing this important work for years to come!
Medi-Cal changes are here. Help members keep coverage!
One out of every three people in Mariposa, San Benito and Santa Cruz counties are Alliance members along with 50% of those residing in Merced and Monterey counties. This means that understanding the changes to Medi-Cal has a big impact on our communities!
The Alliance is working to help as many of our members as possible to keep their Medi-Cal coverage, including reaching out to members via community events, TV ads, social media, text, flyers distributed through schools and more.
Please join us in this effort to maintain access to care for thousands of our community members.
What the community needs to know
Everyone must renew this year. We are sharing three steps for Alliance Medi-Cal members to stay covered:
- Keep your contact information updated with your county Medi-Cal office. Update your address if you have moved.
- Know your renewal date and watch your mail for your renewal letter.
- If you are required to complete renewal paperwork, fill it out and send it back by the deadline.
Community members can continue to sign up for Medi-Cal if they meet the current eligibility requirements.
The Alliance will continue to inform members, providers and the community as DHCS rolls out changes to Medi-Cal benefits and eligibility.
Mga mapagkukunan
- DHCS Medi-Cal changes page.
- Alliance member-facing Pahina ng pagbabago ng Medi-Cal.
- Be careful of Medi-Cal renewal scams.
- Flyer (available in English, Spanish and Hmong).
- Medi-Cal redetermination provider toolkit.
You’re invited: Tri-County Immunization Network Kick-Off
Join us for the Tri-County Immunization Network Kick-Off. The Tri-County Immunization Network facilitates quarterly meetings for immunization and preventive health professionals across Monterey, San Benito and Santa Cruz counties.
Petsa: Thursday, Jan. 22
Oras: 1 p.m. PST
Lokasyon: Online via Microsoft Teams
Sino ang dapat Dumalo sa
- Clinic/FQHC teams (MAs, LVNs, RNs, providers, outreach and other staff).
- Community immunization partners (schools, pharmacies, WIC, COE, promotoras and more).
- Quality, data and immunization program coordinators.
- Public health and prevention staff.
What to expect
Meeting topics include:
- County-level highlights of childhood and adolescent immunization rates.
- Coordinating flu season and other campaigns: disseminating outreach and educational materials.
- Partnering with providers, CBOs, pharmacies and schools to plan and promote immunization events.
- Staying current, managing and communicating changes in immunization guidance.
- Q&A, next steps and a live vote for the spring quarterly meeting date.
Inaasahan namin na makita ka doon!
Submitting EDI claims attachments
Effective January 1, 2026, the Alliance is implementing a new process that allows providers to submit paper attachments for EDI claims. This process applies to our TotalCare (HMO D-SNP), Medi-Cal and IHSS lines of business.
What providers need to do
Submit the claim electronically and include the required attachment indicator in the PWK segment, indicating that supporting documentation will be sent separately.
Form ng Pagsusumite ng Attachment ng Claim
- Complete the appropriate form based on line of business:
- TotalCare: TotalCare Claim Attachment Submission Form.
- Medi-Cal/IHSS: Form ng Pagsusumite ng Attachment ng Claim.
Complete all required fields accurately and attach the completed form to all supporting documentation.
- Print and return completed form and documentation by fax or mail.
- Fax: 831-430-5858.
- Mail:
CCAH
1600 Green Hills Rd. #101
Scotts Valley, CA 95066
Submission timeframes
- Faxed attachments: Must be received within 7 calendar days of claim submission.
- Mailed attachments: Must be received within 10 calendar days of claim submission.
Documentation received after these timeframes will not be used for claim processing.
Failure to include the EDI attachment indicator (PWK segment), use the correct Claim Attachment Submission Form or submit documentation within required timeframes may result in the claim being processed without the attachments or denied due to missing information.
Mga tanong?
Please contact Claims Customer Service at 831-430-5503, Monday–Friday from 8:30 a.m. to 4:30 p.m.
Transitioning Medi-Cal Alliance members to TotalCare (HMO D-SNP)
Through the TotalCare (HMO D-SNP) plan, the Alliance is working to transition enrolled members from separate Medicare and Medi-Cal coverage to an Exclusively Aligned Enrollment (EAE) Dual-Eligible Special Needs Plan (D-SNP). This means that Alliance members get both their Medicare and Medi-Cal benefits from the same organization. This approach simplifies the experience for members and streamlines care delivery for providers.
As TotalCare providers, you will notice changes to benefit coordination, authorization processes and billing. The Alliance has resources to support you with this transition to ensure a smooth experience for your practice and the members you serve.
To get started, visit the Alliance’s TotalCare FAQ webpage to access up-to-date information for providers. To access training videos and additional resources, visit the Mga Webinar at Pagsasanay ng Provider page and enter “TotalCare” into the search field. Following is a list of TotalCare training videos posted to date:
- TotalCare 2026 Model of Care Provider Training.
- Oryentasyon ng Provider ng D-SNP.
- Risk Adjustment 101.
Kung mayroon kang mga tanong, mangyaring makipag-ugnayan sa iyong Kinatawan ng Relasyon sa Provider.
