Get Sample Of Resolution Request

Welcome to the Alliance! Thank you for joining Alameda Alliance for Health (Alliance). The Alliance is a health plan for people who have Medi-Cal. The Alliance works with the State of California to help you get the health care you need.

Dispute resolution processes fall into two major types: Adjudicative processes, such as litigation or arbitration, in which a judge, jury or arbitrator determines the outcome. Consensual processes, such as collaborative law, mediation, conciliation, or negotiation, in which the parties attempt to reach agreement.

A provider dispute is a written notice from the non-participating provider to Health Net that: Challenges, appeals or requests reconsideration of a claim (including a bundled group of similar claims) that has been denied, adjusted or contested. Challenges a request for reimbursement for an overpayment of a claim.

The Federal Independent Dispute Resolution (IDR) system is live.

To submit a claim appeal, complete a Notice of Provider Dispute form (NOPD), attach any relevant and supporting documentation, and submit it to the Claims department within 365 days of the Alliance's action or inaction.

Disputes and Claims means all disputes and/or claims concerning contract price, time, payment, and/or interpretation of this Agreement.

About the IDR Process Starting January 1, 2022, if a provider or facility and a health plan can't agree on the payment amount for an out-of-network service covered by No Surprises rules, they may select IPRO to make a payment determination.

Alliance Group Care provides coverage to In-Home Supportive Services (IHSS) who work in Alameda County. This plan includes coverage for medical, behavioral health/chemical dependency, and pharmacy services. Dental and vision coverage is provided to IHSS workers by the Public Authority (PA).