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It also covers credentialing, contracting, and compliance requirements, including Medi-Cal certification, PCP site review, provider training, notification and appeal processes for adverse decisions, and review procedures for network participation.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/provider-manual-effective-april-1-2025/640227/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/provider-manual-effective-april-1-2025/640227.png","ImageObject",300,407,{"name":42,"@type":43},"4398046744996","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-08","2026-10-22",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",7,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"When does the 2025 Provider Manual take effect?","Question",{"text":63,"@type":64},"It is effective April 1, 2025.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How can providers get the most recent manual version?",{"text":68,"@type":64},"Providers can visit the Alliance provider website or contact the Provider Services Department at 800-700-3874 ext. 5504.",{"name":70,"@type":61,"acceptedAnswer":71},"What major compliance topics are covered in the manual?",{"text":72,"@type":64},"The manual covers credentialing, contracting, program integrity (anti-fraud, waste and abuse), and medical records including confidentiality of information.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},640227,1792849635,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":11,"doc_module":4,"category_id":55,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":133,"file_id":134,"file_url":135,"file_type":136,"file_size":137,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":138,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},4398046744996,"2025 Provider Manual  \nEffective April 1, 2025  \nThis manual is revised periodically. For the most recent version, please visit the Alliance provider website at: [www.thealliance.health/for-providers/](www.thealliance.health/for-providers/ or call the)[ or call the](www.thealliance.health/for-providers/ or call the) Provider Services Department at 800-700-3874 ext. 5504.  \nH E A L T H Y P E O P L E . H E A L T H Y C O M M U N I T I E S .  \n[www.thealliance.health](www.thealliance.health)  \nTable of Contents  \nSECTION 1. INTRODUCTION .............................................................................................................................................. 1  \nORGANIZATION OF THE PROVIDER MANUAL..................................................................................................................................................................... 1  \nACCESSING PROVIDER INFORMATION ................................................................................................................................................................................2  \nALLIANCE MISSION, VISION AND VALUES..........................................................................................................................................................................3  \nOVERVIEW OF ALLIANCE PROGRAMS .................................................................................................................................................................................3  \nMedi-Cal .......................................................................................................................................................................................................................3  \nCalifornia Children Services – Whole Child Model Program ...................................................................................................................4  \nAlliance Care In-Home Supportive Services ..................................................................................................................................................5  \nKey Contact Numbers for Alliance Providers.................................................................................................................................................5  \nSECTION 2. CREDENTIALING, CONTRACTING AND COMPLIANCE ..................................................................................8  \nPARTICIPATING IN THE ALLIANCE NETWORK .....................................................................................................................................................................8  \nMedi-Cal Certification is Required – Screening and Enrollment............................................................................................................9  \nPCP Site Review.........................................................................................................................................................................................................9  \nNew Provider Training............................................................................................................................................................................................9  \nProviders as HIV/AIDS Specialists.......................................................................................................................................................................9  \nNOTIFICATION ABOUT ACTIONS TAKEN AGAINST PROVIDER OR STAFF....................................................................................................................... 10  \nAPPEALING ADVERSE DECISIONS BY THE PEER REVIEW AND CREDENTIALING COMMITTEE ....................................................................................... 10  \nREVIEW PROCEDURE FOR DECISIONS CONCERNING PROVIDER NETWORK PARTICIPATION ....................................................................................... 10  \nCHANGES IN OWNERSH","cbCaieVgHewD8ROM","https://ap.wps.com/l/cbCaieVgHewD8ROM","pdf",6431082,203,"English","# Section 1. Introduction\n## Organization of the Provider Manual\n## Accessing Provider Information\n## Alliance Mission, Vision and Values\n## Overview of Alliance Programs\n## Key Contact Numbers for Alliance Providers\n# Section 2. Credentialing, Contracting and Compliance\n## Participating in the Alliance Network\n## Medi-Cal Certification is Required – Screening and Enrollment\n## PCP Site Review\n## New Provider Training\n## Providers as HIV/AIDS Specialists\n## Notification About Actions Taken Against Provider or Staff\n## Appealing Adverse Decisions by the Peer Review and Credentialing Committee\n## Review Procedure for Decisions Concerning Provider Network Participation\n## Changes in Ownership\n## Debarment, Suspension, Ineligibility or Voluntary Exclusion\n## Program Integrity: Anti-Fraud, Waste and Abuse\n## Medical Records\n## Confidentiality of Information","[{\"question\":\"When does the 2025 Provider Manual take effect?\",\"answer\":\"It is effective April 1, 2025.\"},{\"question\":\"How can providers get the most recent manual version?\",\"answer\":\"Providers can visit the Alliance provider website or contact the Provider Services Department at 800-700-3874 ext. 5504.\"},{\"question\":\"What major compliance topics are covered in the manual?\",\"answer\":\"The manual covers credentialing, contracting, program integrity (anti-fraud, waste and abuse), and medical records including confidentiality of information.\"}]","Provider Manual - Effective April 1, 2025 | PDF",1792708179,512]