Alameda Alliance for Health

Provider questions for Alameda Alliance Medi-Cal, Group Care and Alliance Wellness (D-SNP), including claims submission questions and status of provider disputes. Members use Member Services.

The contact page directs callers to the main office number and its automated prompts to verify Alliance eligibility without waiting for an agent.

Alliance UM / Medical Director line for prior authorization questions; the e-fax is also the route for retrospective authorization requests (within 90 calendar days of service), which must not be sent through the dispute process.

For non-contracted hospitals requesting post-stabilization authorization or transfer of a stable member during business hours; a UM nurse performs telephonic review. Toll-free number shown; the local number is the UM main line.

For non-contracted hospitals after hours, weekends and holidays requesting post-stabilization care authorization or transfer; the Alliance follows up next business day with the authorization number.

Pharmacy and formulary questions, including prior authorization for non-formulary medications (Alliance Wellness uses the Medicare coverage determination form).

USPS claims address for members assigned to an Alliance PCP and for all hospital/facility claims. Members assigned to Children's First Medical Group or CHCN, specialty mental health (Alameda County BHCS) and dental/vision use other addresses; check the member ID card.

Provider claim disputes (Medi-Cal/Group Care within 365 days; Alliance Wellness within 120 days) with the PDR form. Not for retro authorizations, which go to UM.

EDI 837 claims and 835 ERA enrollment and EDI questions; companion guides are on the same page. Enrollment forms may be mailed, faxed or emailed.

Member line for Alliance Medi-Cal and Group Care members. TTY 711 / 1-800-735-2929. Provider staff should use Provider Services.

Member line for Alameda Alliance Wellness Medicare Medi-Cal (D-SNP) members, published as 1-888-88A-DSNP with digits shown.

Provider and member referrals to Alliance case management and disease management programs; members may self-refer.

Submit Medi-Cal provider-preventable condition reporting forms within five business days of discovery.