Provider Manual: Medi-Cal and Group Care

The Alliance requires that contracted providers, medical groups, providers, hospitals, ancillary providers, and other non-hospital facilities, together referred to as "Provider" or "Providers," fulfill the relevant specified responsibilities described in this Provider Manual.

This page includes the following information for providers:

  • About the Manual
  • Updates to the Manual
  • Printing the Manual
  • Viewing the Manual
  • The Provider Manual by Section

About the Manual

The Provider Manual in PDF format on this page contains information on policies for two Alameda Alliance for Health programs: Medi-Cal and Alliance Group Care.

 

Updates to the Manual

The Alliance issues updates to this Manual via the Provider Bulletins, which are mailed to the provider network. Provider Bulletins must be retained for reference. You can find copies of the Provider Bulletins online. The online version of the Manual is updated regularly to incorporate any policy changes communicated in the Provider Bulletins since the last Manual update.

Printing the Manual

The Alliance discourages printing the Provider Manual because of the cost and loss of functionality (e.g., electronic search capability). If you decide to print the manual, we suggest printing only those parts and sections that are relevant to your practice or interest, and printing in black and white.

Viewing the Manual

The Manual was created in Adobe Acrobat portable document format (PDF). To view and utilize the link and search functions of the Manual, you will need to have Adobe Acrobat version 6.0 or higher. If you do not have this software, or have a lower version, you can click on the Adobe Acrobat Reader Icon below to download the software free of charge.

get_adobe_reader 

The Provider Manual is available in four parts for faster download and viewing. Note: larger sections will take a bit longer to download than smaller sections.

Provider Manual

Last updated May 31, 2013

Table of Contents

Part One: Alliance Services (PDF)

Part One: Attachments and Forms (PDF)

Sections 1 - 4:

  • Section 01: Introduction
  • Section 02: Alliance Resources
  • Section 03: Eligibility and PCP Choice
  • Section 04: Provider Marketing

Part Two: Providing Services (PDF)

Part Two: Attachments and Forms (PDF)
Sections 5 - 16:

  • Section 05: PCP Roles & Responsibilities
  • Section 06: Obtaining Authorization for Services 
  • Section 07: Claims
  • Section 08: Service and Referrals for Adults
  • Section 09: Services & Referrals for Newborns, Children, & Adolescents
  • Section 10: Perinatal Services
  • Section 11: Out-of-Plan Services
  • Section 12: Health Education
  • Section 13: Serving Your Diverse Population
  • Section 14: Transportation Services
  • Section 15: Formulary and Pharmacy Services
  • Section 16: Clinical Laboratory Services

Part Three: Monitoring Services (PDF)

Part Three: Attachments and Forms (PDF)
Sections: 17 - 21:

  • Section 17: Quality Improvement
  • Section 18: Complaints & Grievances
  • Section 19: Provider Credentialing
  • Section 20: Facility Site Review
  • Section 21: Practice Guidelines

Part Four: Additional Sections (PDF)

Part Four: Attachments and Forms (PDF)
Sections 22 - 26:

  • Section 22: Provider Connection Website Instructions
  • Section 23: Reporting of Infectious Disease
  • Section 24: Alliance Compliance
  • Section 25: Member Rights and Responsibilities
  • Section 26: Case Management Disease Management (CMDM)