Membership Overview

Overview

Alma Integrity Standards promote our mission by: 1) Creating clear expectations for providers in terms of how to use the Alma platform and tools, and 2) Establishing an environment of safety and respect, while supporting providers in maintaining autonomy of their practices. To learn more about our integrity standards as a whole, please see What are Alma Integrity Standards? 

This article covers Alma’s policies around Membership:

1. Collecting Fees

Eligible insurance clients will be billed automatically through the Alma portal and should not be separately invoiced by their provider. Out-of-pocket invoices should only be used for clients who are not eligible to participate in the Alma Insurance Program, based on the types of insurance that a provider is credentialed with through Alma. In addition, we cannot verify the HIPAA compliance of other platforms including Venmo or Zelle, and your client’s deductibles or out-of-pocket maximums will not be updated accordingly so we ask that you refrain from using these platforms. There are two scenarios in which a provider can invoice clients outside of the portal:

  1. If a client does not pay within 60 days, and the funds are deducted from a provider’s payout. If you do charge a client because they don’t pay through Alma within this time period, you must have documented client consent to have the credit card on file charged through a patient service agreement or authorization form.
  2. If a provider is charging a cancellation fee and has communicated this to clients through their practice policies prior to the onset of treatment.

In order for Alma to remain compliant with our insurance program partners, Alma automatically invoices insurance clients for copays and coinsurance as part of the claims filing process. Our insurance program partners require that clients are invoiced for their correct payment responsibilities. Alma ensures this occurs by invoicing clients for the payment responsibility determined by our eligibility checks, reviewing claims when they return, and making any necessary adjustments so that a client’s Alma invoice ultimately matches their insurance carrier’s Explanation of Benefits. For this reason, providers should never invoice insurance clients for copays or coinsurance themselves.


The only exceptions for collecting a client’s cost-share payment outside of the Alma portal occur when a client’s unpaid Alma invoice has already been deducted from your payout, or you are charging a client an out-of-pocket cancellation fee. Providers remain accountable for client invoices left unpaid after 60 days.

2. Accuracy in Advertisement of Services 

Providers must ensure their Alma profile is accurate and kept up to date. This applies to both information about a provider’s availability for consultations and licenses, licensure as well as information about a provider’s experience, background and/or specialization.

3. Safeguarding Assets

Providers must safeguard Alma’s assets. This includes but is not limited to:

  • Alma rates: Please note our rates are highly confidential. We ask that you please do not share them with others in any capacity, as it is a breach of our confidentiality provision with our payer partners. In the event we learn these rates are shared, you may become ineligible to join Alma. The only exception is if you have administrative staff within your practice who will have access to our rates for client billing purposes.
  • Alma resources, including webinar content

4. Membership Fees

Providers must pay membership fees. Membership will be terminated after 60 days if fees are not paid.

5. Providers Must Communicate Appropriately Toward Alma Staff 

Inappropriate communications include:

  • Disrespectful communication over email 
  • Disrespectful communication over phone/Zoom meeting
  • Name calling, swearing, threatening, hateful language

6. Community Hub Engagement

Providers must engage appropriately with fellow Alma members and follow community guidelines in Community Hub.

7. Group Practice Policy

[For providers who joined before June 2023]: 

Group practice admins cannot request support on behalf of a clinician without their participation. Group practice members must have their own NPI, sign their own MA, and manage their own account. Group practice members must follow Alma guidelines in terms of 1099s, depending on whether they share a bank account.

[For providers who joined after June 2023]:  

Alma doesn’t offer group memberships or support providers in starting their group practice, but it is possible for providers already in a group practice to join Alma as individual members. Group practice admins cannot request support on behalf of a clinician without their participation. 

See Alma's Group Practice Policies to learn more. 

Consultation Request/Directory:

  • All consultation requests and referrals sourced through Alma should stay in the Alma network. If a consult request isn't a good fit, the provider should refer the client to care@helloalma.com.
  • Individual group members must manage their own consultation requests
  • Each group member/ provider will have their own page on Alma’s directory. They can list they are part of a group practice.

Claims Submission: 

  • Group admins/ providers are not allowed to submit claims for other providers in their group.
  • For billing information, Group admins will need to coordinate with individual group members to see billing information and collate it themselves.
  • All members of a group will have their own login to the Alma portal and Alma’s billing portal (for payouts and membership dues, respectively), which means that individual members can make changes to bank account details for both payouts and dues. Alma is not notified when bank account details are changed and will not communicate any changes to group admins if/when these changes are noticed.
  • It is the responsibility of the group owner and the providers within the group to determine how to manage membership dues and payouts. Each provider can pay for their own membership, or the group owner can pay for the cost of all memberships via their business bank account. Alma does not resolve disbursement concerns between members of a group and group owners.
  • Individual members of a group are responsible for ensuring their membership dues are paid and up-to-date. Members will be terminated when their dues are outstanding for 60+ days, even if other members of their group practice are still in good standing. 

8. Responding to Alma

Providers must respond to Alma regarding billing concerns and Integrity Standard policy violations within 5 business days. Failure to respond within this time period will result in membership probation. Probation entails the removal of an Alma profile from the public directory.

9. Practicing within the United States

In compliance with our insurance payer partners, Alma is not able to support providers who render services from outside of the United States. Providers must inform the Alma team if they move outside of the United States and therefore cannot continue their Alma membership.

Please note: This policy only applies to providers who have permanently moved outside the United States. Providers who are U.S. residents but who are temporarily traveling abroad may continue to use Alma's services. Providers using Alma's services while temporarily abroad must have the appropriate liability insurance coverage AND they cannot render services to Optum clients who live in Massachusetts while they (the provider) are traveling abroad.

 

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