Important Notice: Impact of Local Codes Conversion on Prior Authorizations
Please click here for information regarding the impact of the local codes conversion on the prior authorization process.
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!
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 firstname.lastname@example.org or call 510-747-4510.
For more information about ICD-10 codes, providers and getting ready to use these codes, please visit:
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.
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.