Begin New Request
Begin New Request
Communication Request Form
"
*
" indicates required fields
1
Basic Information
2
Additional Information
Email
This field is for validation purposes and should be left unchanged.
i
Before submitting a communications request, please make sure:
- You search C360 for
WP-076
and review the communications and health literacy workflow
- The material and/or request has gone through all required team and supervisor reviews set in your team procedures
If you have any questions about the process, please email
communicationsteam@alliancehealthplan.org
.
Basic Information
Your Email
*
List the Emails of Anyone You wish to CC
Multiple emails should be comma-separated (e.g. dfuller@alliancehealthplan.org, balexander@alliancehealthplan.org)
Department
*
Please select
Access
Care Management
Claims and Enrollment
Clinical Education and Training
Community Health and Wellbeing
Compliance
DEI
Executive
Facilities
Finance
HR
IT
ODL
Office of Legal and Public Affairs
OPPMO
Pharmacy
Population Health
Practice Transformation
Provider Network
Quality Management
Transformation Office
Transition to Community Living
Utilization Management
Is this a new communication or an update to existing published information?
For example, if you are uploading a new version of an existing document or adding additional content to an existing webpage those would be an "Update".
New
Update
Subject of communication
Communication detail
Tell us what you want to communicate. Please be sure to include the purpose of the communication as well as any relevant background information.
Communication type
AllianceHealthPlan.org - Provider Update
AllianceHealthPlan.org - Document Library
AllianceHealthPlan.org - Webpage
AllianceHealthPlan.org - Alliance News
AllianceHealthPlan.org - Events Calendar
AllianceHealthPlan.org - Question & Answer
The Grid (intranet)
Constant Contact Event/Email
Social Media
Print material (flyer, postcard, rack card or similar)
Other
Exact webpage address (URL) / title
*
Tell us what page this should appear on (URL or page title). If a new page is needed, describe where on the website the new page should appear.
Where do you want this communication posted?
Is this a provider only event?
Yes
No
Is this a handbook update?
*
E.g. concerns a document that is printed and distributed by Wellcare. If you aren't sure, you can review
this list
of those documents. If your change concerns one of these documents, then click yes!
Yes
No
Specify other nature of request
*
Specify other nature of request
Intended audience(s)
Who are you trying to reach with this information?
Priority
What level of priority is this request?
Normal
High
Urgent
Does this communication need to go through health literacy review?
Please note that any member communications are required to go through health literacy review. Any public, staff, or provider communications can also benefit from health literacy review. A health literacy review will provide recommendations that will make the communication easier for the audience to read and understand. All suggestions are recommendations, and the content owner has final say on what edits are incorporated.
Yes
No
Unsure (Health Literacy Team can help you decide)
Notice:
Health literacy reviews have been paused until further notice.
Does this material need to go to the state for review?
Yes
No
Unsure (Health Literacy Team can help you decide)
Requested completion date
If you are submitting a new document, please ensure that you've alloted time for it to undergo professional design and accessibility review and remediation. It will be returned to you for final review prior to posting.
MM slash DD slash YYYY
Do not publish until
If the request cannot be published until a certain date, please select a date
MM slash DD slash YYYY
Expiration publishing date
If the request has an expiration date, please select one below
MM slash DD slash YYYY
Upload Files
When uploading a PDF, please also upload the document in its original format, such as Word or Excel. That will make it easier for us to make any accessibility or design changes.
Main Document
This might include images or graphics
Drop files here or
Select files
Max. file size: 128 MB.
If there is additional information required based on prior selections those fields will appear below. If blank, please proceed to submit once complete.
If you are uploading a new document, additional information will be requested below.
If you are submitting a document update, event or news item, just click the submit button.
Attestation
*
By submitting this request, I acknowledge that I have read and understand the process flow outlined in Communications–Health Literacy Review (WP-076).
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Website Page Information
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Page Title
*
Page Title
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Page Location
*
URL if it is an existing page. Section and subsection where it should appear if new.
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Categorization
This field is hidden when viewing the form
Categorization
Chose the best fit of the available options.
Parent Name
Parent Name
Alliance Health
Community
Members
Providers
Unlisted or Uncategorized
Term Name
Term Name
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Document Notification Tool
Hidden during development
This field is hidden when viewing the form
Is this document update significant?
This needs definition.
Yes
No
This field is hidden when viewing the form
Changes summary
Please summarize the major changes and a notification email will be sent to the folks following this document for changes.
This field is hidden when viewing the form
Actual Document URL
The URL of the document that needs to be replaced or the URL of the page where the document is on alliancehealthplan.org
New Document Information
You selected that this is a new document to be added to our document library. Please fill out the information below. This information allows users to easily find a specific type of document or information. Please fill this out to the best of your ability. We must have this information before posting the document. If you do not fill out this form, we will reach out to ask for this information which can slow down project timeline.
Main document language
English
Spanish
Document Type
Applies to new documents only
Brochure
Codes, lists, and rates
Directory
FAQs
Fee & checkwrite schedules
Flyer
Form
Guidelines
Handbook
Informational
Instructions
Minutes
Newsletter
Presentations and Training
Report
Survey
Third-party Resource
Title
The document title should be short, clear, descriptive, and not contain any special characters. This will be what people see in the label for the doc.
Document Teaser
The teaser is a description of what the document is. It should be a single sentence up to 160 characters that describes the document’s purpose.
If you you are submitting a new document, please ensure that you've alloted time for it to undergo professional design and accessibility review and remediation. It will be returned to you for final review prior to posting.
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