For Providers

 

Provider Alert: 2019-2020 Seasonal Influenza Vaccines

The Alliance is pleased to offer coverage of the flu shot. All eligible Alliance Medi-Cal members between the ages of 19 to 64 years old, and Alliance Group Care members of any age can now get a flu shot if/when supplies are available and offered at your office.

Please click here for more information regarding this update.

 

 

Provider Alert: Provider Appointment Availability Survey (PAAS)

From May to December of 2019, the Alliance is conducting the 2019 Provider Appointment Availability Survey (PAAS). All health plans in California are required to survey providers to assess the availability of routine and urgent appointments.

Please click here for more information regarding this update.

 

 

Provider Alert: The California Department of Health Care Services (DHCS) Timely Access Monitoring Survey

The California Department of Health Care Services (DHCS) is conducting a quarterly monitoring survey of all Medi-Cal managed care health plans (MCPs) to assess provider compliance with appointment availability and wait time regulations.

Please click here for more information regarding this update.

 

 

Provider Alert: The New Alliance Health Homes Program (HHP)

On Monday, July 1, 2019, we launched the Alliance Health Homes Program (HHP). This new Medi-Cal benefit helps eligible Alliance members with certain health care needs – like diabetes, hypertension or kidney disease – and who meet other specific criteria get the health care, support, and services that they need to work towards their health care goals.

Please click here for more information regarding this new benefit.

 

 

Provider Alert: Thursday, August 1, 2019: Important Update on eviCore and Radiology Service Authorizations

Effective, Thursday, August 1, 2019, eviCore will no longer provide radiology service authorizations for the Alliance. The radiology services that require a prior authorization (PA) are unchanged. All radiology service authorizations will need to be submitted directly to the Alliance Utilization Department by fax at 1.855.891.7174, and follow the standard process using our prior authorization (PA) form.

Please click here for more information regarding this update.

 

 

Reading the Alliance Statement of Remittance

As a part of the Alliance weekly check run, we provide a Statement of Remittance, which includes claims that were finalized (paid or denied) for that week. We are providing this communication to help our provider partners understand the information included on the Statement of Remittance. Please click here for more information.

 

 

Provider Alert: Prinston Pharmaceutical Inc. Irbesartan and Irbesartan HCTZ Tablets, Drug Recall Notification

Please click here for information regarding this drug recall notification.

 

 

Provider Alert: Retrospective Authorization Process, effective Monday, March 11, 2019

Please click here for more information regarding this change.

 

 

Prior Authorization Grid:

Please click here to view the Alliance Prior Authorization Grid.

 

Provider Alert: Approved List of Security Prescription Printers

As of Monday January 1, 2019, the Health and Safety Code section 11162.1(a) (15) requires prescription forms for controlled substances to be printed with a unique serialized number. Please click here for more information.

 

Provider Alert: Alameda Alliance for Health (Alliance) has expanded Diplomat Specialty Pharmacy services to cover hepatitis C. Please see below for FAQs & enrollment form.

Please click here for FAQs
Please click here for enrollment form

 

 

Provider Alert: Contact Information for Non-Contracting Hospitals Post Stabilization Care or Transfer Request

This notification is to share with you the contact information for non-contracting hospitals post stabilization care or transfer request. Please click here for more information.

 

 

Provider Alert: DEA-X Waiver Training

Dear Providers, The DEA-X Waiver training is an identified and important tool in treating opioid disorder. Community Partners are offering DATA 2000 Waiver trainings across California from September to December 2018. Space is limited and registration will be filled on a first come, first served basis, so please register promptly: https://www.surveymonkey.com/r/WaiverTrainingHSS

 

Provider Alert: The Centers for Disease Control and Prevention (CDC) Health Update - Recommendations for Managing and Reporting Shigella Infections

Please click here for more information regarding this CDC health update.

 

Provider Alert: Rugby Diocto Liquid/Syrup Drug Recall Notification

Please click here for information regarding this drug recall notification.

 

Important Notice: Update on Member Communication

Please click here for information regarding results from our annual member experience survey.

 

Important Notice: Electronic Funds Transfer (EFT) for Provider Payments

Please click here for information regarding EFT provider payments. If you wish to enroll please complete the EFT Enrollment form.   

 

 

Important Notice: Revisions to 2016 Coverage of Mental Health and Substance Use Disorder Benefits

Please click here for information regarding benefit revisions.

 

 

Important Notice:  Electronic Remittance Advice

Please see notice for important information about Electronic Remittance Advice updates.

 

 

Important Notice: Standardized Reason Code Crosswalk

Please click the link to access the crosswalk.

 

 

Transition of Members on Dialysis to Davita

Effective September 1, 2015 the Alliance has chosen Davita HealthCare to be the preferred provider for outpatient dialysis services. Please refer to the Provider Frequently Asked Questions for more information.

 

Important Notice - Prior Authorization Changes

Effective September 1, 2015, about 500 outpatient specialty procedures and surgeries no longer require prior authorization. In addition, the authorizations rules for home health services (including home infusion) have been revised. Only the medical care component, administration of infusion services, and physical rehabilitation services require authorization. The Alliance will no longer require prior authorization for miscellaneous items linked to home health or home infusion. Coming soon there will be one consolidated list showing all procedural codes that will require a prior authorization.  In the meantime, please refer to the prior authorization grid for a general list of services that require authorization.

 

HEALTHsuite - Go Live September 1, 2015

The Alliance will be going live on a new claims payment system on September 1, 2015. This new system called HEALTHsuite includes new functionality such as ICD-10 capabilities and will allow us to provide better support to both our members and our providers. The go live should be seamless to our members however, our providers will see a few changes which are being communicated out by our Provider Relations team. If  you are a provider and have questions, you can reach the Provider Relations team at 510-747-4510.

Below are HEALTHsuite implementation resource documents for your reference:

HEALTHsuite Implementation Provider Communications

HEALTHsuite Claims Messages

List of Changes in HEALTHsuite

What Stayed the Same in HEALTHsuite

We have been working diligently on the implementation and are very excited that our go live date is almost here!

 

ICD-10 Assistance

On October 1, 2015, all entities covered by the Health Insurance Portability and Accountability Act (HIPAA) must be able to successfully conduct health care transactions using ICD-10 diagnosis and inpatient procedure codes. The implementation date is proposed by the Centers for Medicare & Medicaid Services (CMS). ICD-9 diagnosis and inpatient procedure codes cannot be used for services provided on or after the implementation date of October 1, 2015.  After October 1, 2015, we will not accept ICD-9 coded claims with service dates past October 1, 2015. These claims will be denied and will have to be re-submitted with ICD-10 codes.

If you have any further questions, please contact our Provider Management department at providerservices@alamedaalliance.org or call 510-747-4510.

For more information about ICD-10 codes, providers and getting ready to use these codes, please visit:

http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html.

Below are links for Providers who are not ready for ICD-10 to review as options to assist in converting ICD-9 claims to ICD-10 claims.

http://www.icd10charts.com/

http://www.icd10data.com/Convert

http://www.icd10codesearch.com/

Top 100 Commonly Billed Codes

ICD-10 Transition Grid 

 

Nurse Advice Line - Starting September 1, 2015

Free Nurse Advice Line service for Medi-Cal & Group Care members. Available 24 hours/7 days a week. Please see flyer for more information.

 

Important Notice: Authorization Change starting July 20, 2015

Please see notice for more information.

 

Important Notice: Authorization Change starting March 23, 2015

Please see notice for more information.  

  

HEDIS Resources

Monitor patient health, prevent complications, and get helpful tips to reflect the quality care you provide.

Welcome Alliance Providers

Alameda Alliance for Health works with our provider network to improve the health of our members. Here you can locate provider resources designed just for you.

Need assistance? Speak to a Provider Service Representative at 510-747-4510.

 

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