Forms & Resources

View or download reference materials and forms.

To receive any of these documents by fax or mail, email or call us at 510-747-4510. We are available Monday – Friday 7:30 am to 5:30 pm.

Alliance Authorization Request Form

Use this form to submit requests for prior authorization to the Alliance Authorizations department: 
Alliance Authorization Request Form. Click here for instructions.

Medication Request Forms

Use this form to submit requests for prior authorization of drugs for Alliance Medi-Cal and Alliance Group Care members to PerformRx, the Alliance's Pharmacy Benefit Manager (PBM). 

Medication Request Form

Member Grievance & Appeals Process

If you become aware of a member with a problem or complaint about the Alliance, its policies, or its providers, please give the member this Complaint Form and a copy of the Member Guide to the Grievance and Appeals Process.

Member Guide to the Grievance & Appeals Process - English  Spanish  Chinese  Vietnamese

Member Complaint Form - English  Spanish  Chinese  Vietnamese

Schedule an Interpreter

Use the Interpreter Request Form to request an interpreter, or sign language interpreter, for a member’s health care visit. Please request by fax or phone at least five (5) days in advance when possible.

Interpreter Request Form

Transportation Request Form & FAQ

Use this form to request Non-Emergency Medical Transportation or Non-Medical Transportation from Logisticare:

Physician Certification Form - Request for Transportation - English

Frequently Asked Questions About Medi-Cal Transportation Benefits:

Medi-Cal Transportation Benefits: Provider Frequently Asked Questions (FAQ)