Compliance Program
Help Us Help You
Astrana Health has published a Compliance Program, which reflects our attention to caring for all of our providers and members’ guidance to ensure that our business is conducted in an ethical manner. Your adherence to complying with our Compliance Program is absolutely critical to our mutual success in delivering quality care.
If you have any questions or concerns, please contact our Compliance Department via phone, fax, email, or mail.
Compliance Hotline:844-975-2651 (Available 24/7)
Website:astranahealth.ethicspoint.com
Email:Compliance@astranahealth.com
Mail:Attention: Compliance Department
1668 S. Garfield Ave., 2nd Fl.
Alhambra, CA 91801
Additional Compliance Resources
Code of Conduct
Astrana Health Standards of Conduct Training
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Astrana Health Standards of Conduct
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DHCS Screening and Enrollment
APL Highlights
DHCS Managed Care All Plan Letters
DHCS Providers and Partners
Provider Enrollment FAQ 5.31.2018
Excluded Parties
In accordance with the Network Medical Management group policy, all providers, vendors, and contractors are prohibited from contracting with Excluded Parties.
Excluded Parties
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Policy Template Exclusion Screenings
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Screening Against Government Exclusions Lists Guidance Overview
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Miscellaneous
Behavioral Health Treatment FAQ
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California Department of Developmental Services
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Health Plan Language Assistance
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Hospice & Palliative Care
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Medicare Managed Care Manual (Refer to Chapter 9 and 21)
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Office of the Inspector General (OIG) Exclusion Database
Patient Rights and Responsibilities
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Provider Compliance
Policies and Procedures
If you need to obtain a copy of a specific policy, please contact our Provider Services Department from Monday to Friday between 9:00 AM and 5:00 PM PST at (626) 943-6100.
Breach of Protected Health Information
Identifier Standards
Privacy
References
Security
Transactions and Code Sets
Tracking Log
Sample Employee Training and Screening Tracker
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Health Education
Utilization Management
California Children’s Services Conditions
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Interdisciplinary Care Team (ICT) Training
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Preventive Services
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Astrana Health Sterilization and Informed Consent Training
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Astrana Health California Children’s Services (CCS) Training
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General Education Materials
Access To Care Flyer – Chinese
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Access To Care Flyer – English
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Access To Care Flyer – Spanish
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Blue Shield Promise Health Education Link
California Department of Developmental Services Regional Centers
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CHCS Health Literacy Fact Sheets
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Dementia Care Training
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Dietary Guide for Americans
LA Care Health Education Link
Medi-Cal Early & Periodic Screening Diagnosis & Treatment For Children & Young Adults
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Sterilization – Consent Form PM 330 Department of Health Services
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Sterilization – Permanent Birth Control for Men
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Sterilization – Permanent Birth Control for Men (Spanish)
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Sterilization – Permanent Birth Control for Women
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Sterilization – Permanent Birth Control for Women (Spanish)
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WIC Program Guide
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Resources
Training Material
Quick Resources & Training Material
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Health Home Process
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Zelis Training Material
ePayment Center (ACH) Portal Training Guide
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Zelis Payment Network (ZPN) Portal Training Guide
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HEDIS
LA Care HEDIS Resources
2020 HEDIS Measures
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HEDIS 2020 Hybrid Measure Quick Guide
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HEDIS 2020 Administrative Measure Quick Guide with Codes
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HEDIS 2020 Chart Submission Requirements
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HEDIS 2020 Hybrid Measure
PM160 Notification Letter
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Updated PM160 Notification Letter
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QI Interventions Reported by Top Performing IPAs
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Templates
Claims
Provider Dispute Resolution Request Form (ADV)
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Provider Dispute Resolution Request Form (AHC)
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Provider Dispute Resolution Request Form (ALPHA)
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Provider Dispute Resolution Request Form (APC)
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Provider Dispute Resolution Request Form (APCMG)
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Provider Dispute Resolution Request Form (BAIPA)
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Provider Dispute Resolution Request Form (CFC)
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Provider Dispute Resolution Request Form (CVIPA)
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Provider Dispute Resolution Request Form (GOM)
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Provider Dispute Resolution Request Form (LSMA)
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Provider Dispute Resolution Request Form (NCPN)
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Waiver of Liability Statement
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Utilization Management
ALPHA Authorization Form
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BAIPA Authorization Form
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CFC Authorization Form
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EHIPA Authorization Form
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AHC Authorization Request Form
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APC and Affiliate IPAs Authorization Form
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Provider Training
Astrana Health is committed to conducting its business operations with the highest ethical standards and in full compliance with healthcare industry standards and regulations and all applicable Federal and State laws. In keeping with this pledge, Astrana Health has implemented a comprehensive Training Program for network providers inclusive of Compliance items and Utilization Management Protocols and Policies. All network providers are required to review and attest annually to completing the trainings using the 2024 Annual Provider Training Attestation Form.
Fraud, Waste & Abuse (FWA) | General Compliance
Medicare Part C & D – General Compliance Training 2020
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Medicare Part C & D – Fraud Waste and Abuse Training 2020
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Fraud & Abuse MLN Booklet (4649244)
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Astrana Health Fraud Waste and Abuse (FWA) Training 2022
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Astrana Health General Compliance Training 2024
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Cultural Competency
Cultural Competency Training
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HIPAA Privacy Training
HIPAA Basics for Providers 2022 (MLN Booklet)
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Astrana Health HIPAA Training – 2022
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Standard of Conduct
Astrana Health Standard of Conduct
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Model of Care Training (MOC)
Alignment Provider – MOC Training
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Blue Shield Promise – CMC and D-SNP MOC Training
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Brand New Day (BHC) – SNP MOC Training
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Health Net SNP MOC Training
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L.A. Care – MOC Overview (CMC manual, sec. 4.5.1)
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Molina Healthcare MOC Training
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SCAN Health Plan SNP MOC Training
Central Health Plan SNP MOC Training
United Healthcare SNP MOC Training
Wellcare – SNP MOC Training
Additional Provider Training Resources
Initial Health Assessment Guidelines
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SCAN IHA Requirements
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Timely Response To Grievance Requests – Alpha Care Medical Group
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Timely Response To Grievance Requests – LaSalle Medical Associate
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Astrana Health Contracted SPECIALISTS Responsibilities
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Astrana Health Contracted PCP Responsibilities
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Astrana Health Contracted OB-GYN Providers Responsibilities
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Access to Care Standards
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Balance Billing Training
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Fraud Impersonation Guidelines
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2024 Astrana Health Provider Manual
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