Kinilala ang Alyansa para sa natatanging pagganap
Kinilala ng California Department of Health Care Services (DHCS) ang Alliance dahil sa paglampas sa mga pamantayang itinakda ng Measurement Year 2024 (MY24) Managed Care Accountability Set (MCAS). Nakamit namin ang bawat sukatan sa apat na larangan ng MCAS, kabilang ang:
- Kalusugan ng mga Bata.
- Kalusugang Reproduktibo at Pag-iwas sa Kanser.
- Kalusugan ng Pag-uugali.
- Pamamahala ng Talamak na Sakit.
Ang MCAS ay isang hanay ng mga sukat ng pagganap na pinipili ng DHCS para sa taunang pag-uulat ng mga planong pinamamahalaang pangangalaga ng Medi-Cal.
High performance in each of these areas is a result of collaborative efforts between Alliance staff, our provider network and community-based organizations. We want to thank our valued providers and partners for their steadfast commitment to improving health outcomes and offering the best possible care for our members across Mariposa, Merced, Monterey, San Benito and Santa Cruz counties.
Sinusuportahan ng Alliance ang mga provider sa pagkamit ng mataas na performance sa pamamagitan ng pag-aalok ng:
- Iba't ibang tagapagbigay ng serbisyo mga pagsasanay.
- Mga oportunidad sa pagpopondo sa pamamagitan ng Medi-Cal Capacity Grant Program.
- Mga insentibong pinansyal sa pamamagitan ng Programang Insentibo na Nakabatay sa Pangangalaga.
We also tailor communications for members to encourage service utilization using channels including media campaigns, pakikipag-ugnayan nang personal, ang aming programa sa pagte-text, Pahina ng Facebook, blog at newsletter ng miyembro.
Noong 2025, nakamit din ng Alliance ang buong Health Plan at Health Equity Accreditation mula sa National Committee for Quality Assurance. Ngayong taon, ipinagdiriwang ng Alliance ang 30 taon ng pagbibigay ng mapagkakatiwalaang pangangalaga sa mga lokal na komunidad. Inaasahan namin ang patuloy na pagpapabuti ng mga resulta ng kalusugan sa pamamagitan ng pagbibigay ng naa-access at de-kalidad na pangangalagang pangkalusugan sa mga darating na taon!
Maaari kang magbasa nang higit pa tungkol sa mga partikular na sukat at pagganap ng MCAS sa fact sheet ng DHCS.
Reminder: No member fees for forms or providing information
Ang California Department of Health Care Services (DHCS) reminds contracted providers that, under California Health & Safety Code Section 123114, Medi-Cal members may not be charged for completing forms or providing information that supports a claim or appeal for a public benefit program.
Medi-Cal members have the legal right to access their medical records. Providers may charge:
- $0.25 per page for paper copies, plus a reasonable clerical fee.
- $0.50 per page for copies of microfilm records, including diagnostic images.
- A reasonable fee not to exceed actual costs for copies of diagnostic films, such as x-ray, MRI, CT and PET scans.
For more information, see the Medical Board of California’s page on Patient Access to Medical Records.
What to know about TotalCare billing requirements
TotalCare (HMO D-SNP) is the Alliance’s Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) for members eligible for both Medicare and Medi-Cal.
Submitting claims
- TotalCare providers must follow Medicare billing requirements to avoid delayed or denied claims.
- Claims may be submitted electronically using the same payer IDs.
- Providers are encouraged to review billing practices to ensure alignment with Medicare requirements when serving TotalCare members.
More information is available on our Claims webpage. For billing support, call the TotalCare Claims Customer Service line at 831-430-5503, option 3, Monday – Friday, 8:30 a.m. to 4:30 p.m.
