Network Medical Management is now Astrana Health Management

Provider Resources

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: https://astranahealth.ethicspoint.com
Email: Compliance@astranahealth.com

Mail: Attention: Compliance Department
1668 S. Garfield Ave., 2nd Fl.
Alhambra, CA 91801

Additional Compliance Resources

NMM Standards of Conduct Training
Download PDF
Astrana Health Standards of Conduct
Download PDF
APL Highlights
DHCS Managed Care All Plan Letters
Visit Website
DHCS Providers and Partners
Visit Website
Provider Enrollment FAQ 5.31.2018
Excluded Parties
Download PDF
Policy Template Exclusion Screenings
Download PDF
Screening Against Government Exclusions Lists Guidance Overview
Download PDF
Behavioral Health Treatment FAQ
Download PDF
California Department of Developmental Services
Download PDF
Health Plan Language Assistance
Download PDF
Hospice & Palliative Care
Download PDF
Medicare Managed Care Manual (Refer to Chapter 9 and 21)
Download PDF
Office of the Inspector General (OIG) Exclusion Database
Visit Website
Patient Rights and Responsibilities
Download PDF
Provider Compliance
Visit Website
Breach of Protected Health Information
Identifier Standards
Privacy
References
Security
Transactions and Code Sets
Sample Employee Training and Screening Tracker
Download PDF

HEDIS

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
Download PDF
HEDIS 2020 Chart Submission Requirements
Download PDF
HEDIS 2020 Hybrid Measure
PM160 Notification Letter
Download PDF
Updated PM160 Notification Letter
Download PDF
QI Interventions Reported by Top Performing IPAs
Download PDF

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 2023 Annual Provider Training Attestation Form.

Medicare Part C & D - General Compliance Training 2020
Download PDF
Medicare Part C & D - Fraud Waste and Abuse Training 2020
Download PDF
NMM General Compliance Training 2022
Download PDF
NMM Fraud Waste and Abuse (FWA) Training 2022
Download PDF
Fraud & Abuse MLN Booklet (4649244)
Download PDF
Cultural Competency Training
Download PDF
HIPAA Basics for Providers 2022 (MLN Booklet)
Download PDF
NMM HIPAA Training - 2022
Download PDF
Astrana Health Standard of Conduct
Download PDF
Alignment Provider - MOC Training
Download PDF
Blue Shield Promise - CMC and D-SNP MOC Training
Download PDF
Brand New Day (BHC) - SNP MOC Training
Download PDF
Health Net SNP MOC Training
Download PDF
L.A. Care – MOC Overview (CMC manual, sec. 4.5.1)
Download PDF
Molina Healthcare MOC Training
Download PDF
SCAN Health Plan SNP MOC Training
Visit Website
Central Health Plan SNP MOC Training
Visit Website
United Healthcare SNP MOC Training
Visit Website
Wellcare - SNP MOC Training
Visit Website
Initial Health Assessment Guidelines
Download PDF
NMM Contracted OB-GYN Providers Responsibilities
Download PDF
NMM Contracted PCP Responsibilities
Download PDF
NMM Contracted SPECIALISTS Responsibilities
Download PDF
SCAN IHA Requirements
Download PDF
Timely Response To Grievance Requests - Alpha Care Medical Group
Download PDF
Timely Response To Grievance Requests - LaSalle Medical Associate
Download PDF
2023 NMM Provider Manual
Download PDF
Access to Care Standards
Download PDF
Balance Billing Training
Download PDF
Fraud Impersonation Guidelines
Download PDF

Health Education

California Children’s Services Conditions
Download PDF
NMM California Children’s Services (CCS) Training
Download PDF
NMM Sterilization and Informed Consent Training
Download PDF
Interdisciplinary Care Team (ICT) Training
Download PDF
Preventive Services
Download PDF
Access To Care Flyer – Chinese
Download PDF
Access To Care Flyer - English
Download PDF
Access To Care Flyer - Spanish
Download PDF
Blue Shield Promise Health Education Link
Visit Website
California Department of Developmental Services Regional Centers
Download PDF
CHCS Health Literacy Fact Sheets
Download PDF
Dementia Care Training
Download PDF
Dietary Guide for Americans
Visit Website
LA Care Health Education Link
Visit Website
Medi-Cal Early & Periodic Screening Diagnosis & Treatment For Children & Young Adults
Download PDF
Sterilization - Consent Form PM 330 Department of Health Services
Download PDF
Sterilization - Permanent Birth Control for Men
Download PDF
Sterilization - Permanent Birth Control for Men (Spanish)
Download PDF
Sterilization - Permanent Birth Control for Women
Download PDF
Sterilization - Permanent Birth Control for Women (Spanish)
Download PDF
WIC Program Guide
Download PDF

Resources

Quick Resources & Training Material
Download PDF
Health Home Process
Download PDF
ePayment Center (ACH) Portal Training Guide
Download PDF
Zelis Payment Network (ZPN) Portal Training Guide
Download PDF

Templates

Provider Dispute Resolution Request Form (ADV)
Download PDF
Provider Dispute Resolution Request Form (AHC)
Download PDF
Provider Dispute Resolution Request Form (ALPHA)
Download PDF
Provider Dispute Resolution Request Form (APC)
Download PDF
Provider Dispute Resolution Request Form (APCMG)
Download PDF
Provider Dispute Resolution Request Form (BAIPA)
Download PDF
Provider Dispute Resolution Request Form (CFC)
Download PDF
Provider Dispute Resolution Request Form (CVIPA)
Download PDF
Provider Dispute Resolution Request Form (GOM)
Download PDF
Provider Dispute Resolution Request Form (LSMA)
Download PDF
Provider Dispute Resolution Request Form (NCPN)
Download PDF
Waiver of Liability Statement
Download PDF
AHC Authorization Request Form
Download PDF
ALPHA Authorization Form
Download PDF
APC and Affiliate IPAs Authorization Form
Download PDF
BAIPA Authorization Form
Download PDF
CFC Authorization Form
Download PDF
EHIPA Authorization Form
Download PDF