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For the most recent version, please visit the Alliance provider website at: [www.thealliance.health/for-providers](www.thealliance.health/for-providers/ or call)[/](www.thealliance.health/for-providers/ or call)[ or call](www.thealliance.health/for-providers/ or call) the Provider Services Department at 800-700-3874 ext. 5504.  \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  \nSECTION 2. CREDENTIALING, CONTRACTING AND COMPLIANCE ..................................................................................8  \nParticipating in the Alliance Network ..............................................................................................................................................................8  \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 Ownership ........................................................................................................................................................................................ 11  \nDebarment, Suspension, Ineligibility or Voluntary Exclusion .............................................................................................................. 11  \nDebarment, Suspension, Ineligibility of Prescribing Providers ........................................................................................................... 11  \nProgram Integrity: Anti-Fraud, Waste and Abuse..................................................................................................................................... 12  \nMedical Records ..................................................................................................................................................................................................... 14  \nAccessibility Standards ....................................................................................................................................................................................... 16  \nData Exchange Framework ............................................................................................................................................................................... 16  \nUnlawful Harassment .......................................................................................................................................................................................... 17  \nSECTION 3. THE ROLE OF THE PRIMARY CARE PROVIDER.........................................................","cbCaiqzK28ijyWsM","https://ap.wps.com/l/cbCaiqzK28ijyWsM","pdf",6350423,203,"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# SECTION 2. CREDENTIALING, CONTRACTING AND COMPLIANCE\n## Participating in the Alliance Network\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## Debarment, Suspension, Ineligibility of Prescribing Providers\n## Program Integrity: Anti-Fraud, Waste and Abuse\n## Medical Records\n## Accessibility Standards\n## Data Exchange Framework\n## Unlawful Harassment\n# SECTION 3. THE ROLE OF THE PRIMARY CARE PROVIDER\n## Facility Site Review and Medical Record Review\n## Primary Care Provider Selection\n## Initial Health Appointment\n## Early and Periodic Screen, Diagnosis and Treatment (EPSDT)\n## Preventive Care\n## Adverse Childhood Experiences (ACEs) Screening\n## Alcohol and Drug Screening, Assessment, Brief Interventions and Referral to Treatment (SABIRT)\n## Enhanced Primary Care Pain Management Program\n## Seniors and Persons with Disabilities\n## Comprehensive Tobacco Cessation Services\n## Utilization Management Program","[{\"question\":\"How can providers access the most recent version of this Provider Manual?\",\"answer\":\"Providers are directed to the Alliance provider website for the latest updates. The manual also provides contact details for the Provider Services Department if assistance is needed.\"},{\"question\":\"What compliance topics are covered in Section 2?\",\"answer\":\"Section 2 covers credentialing, contracting, and compliance items such as participating in the Alliance network, adverse actions and appeals, ownership changes, debarment and suspension topics, and program integrity measures including anti-fraud, waste, and abuse.\"},{\"question\":\"What responsibilities are included for the primary care provider?\",\"answer\":\"The manual outlines duties such as facility site review and medical record review, primary care provider selection, the initial health appointment, EPSDT and preventive care, specific screenings, pain management, services for seniors and persons with disabilities, tobacco cessation services, and utilization management.\"}]","Provider Manual - Effective January 1, 2025 | PDF",1792711284,512]