top of page
a48afe_3253a1e1b61c49b4af079fbab7fabc01~mv2.png
ALIVIA-Compliance Quality_00_Ing_Color (002).png

Commitment to Quality and Compliance at Alivia Health

​

The Quality and Compliance Team (QCT) guides all Alivia Health LLC (Alivia Health) business units to ensure adherence to applicable state and federal laws and regulations, as well as ethical standards.

​

Compliance Function

​

The essential function of the Compliance Program is to identify and address any violations that may occur. This is achieved by monitoring existing regulations, providing continuous training to the Alivia Health workforce, and investigating potential non-compliance with policies and procedures.

​

Quality Function

​

Through the Quality Program, the Compliance and Quality Team drives innovation and continuous improvement in the adoption of industry’s best practices. Its goal is to ensure that our patients receive quality services, products, and medications by optimizing the safety, efficacy, and efficiency of our services in accordance with the accreditation standards of URAC, ACHC, and The Joint Commission programs. Alivia Health ensures compliance with the Quality Program through continuous monitoring led by the Patients First Committee. This committee has the crucial role of identifying areas of opportunity for improving our processes.

​

Reporting Channels

​

As part of our commitment to putting patients first, we encourage employees, business partners, patients, and/or representatives of Alivia Health to report if they believe they have witnessed any irregularities associated with any of our business units regarding regulatory matters, policies, or the Code of Conduct. We also urge you to report any event that affects the quality of our health services.

​

To do this, you can use the following resources:

​

​

​

You can also contact the Alivia Health Compliance and Quality Department for matters related to Compliance and Quality through any of the following means:

​

​

Protection of Medical Information (HIPAA)

​

The Health Insurance Portability and Accountability Act (HIPAA) protects our patients' medical information. If a patient believes their protected health information has been disclosed in a manner not permitted by law, they can file a complaint without fear of retaliation.

​

You can do so through:

​

​

​

Other Resources for Reporting Complaints

​

In addition, there are other resources available for reporting complaints:

​

  • Department of Health: (787) 765-2929

  • Patient Advocate:

    • Metro Area: (787) 977-1100

    • Island-wide: 1-800-981-0031

  • Advocate for Persons with Disabilities:

    • Phone: (787) 725-2333

    • TDD/TAD: (787) 725-4014

    • Toll-free: 1-800-981-4125

  • Advocate for the Elderly:

    • Main Office: (787) 721-6121

    • Region I: (787) 919-7930

    • Ponce: (787) 841-1180 / 1181

  • Medicare: 1-800-833-0356

  • Centers for Medicare & Medicaid Services Help Center: 1-800-985-3059

  • ACHC:

  • URAC:

  • The Joint Commission:

​

Accreditations

​

Utilization Review Accreditation Commission (URAC)

​

URAC is a leading organization that promotes quality in healthcare. It achieves this through accreditation, certification, and the measurement of rigorous standards that validate our company's commitment to the continuous improvement of patient care. URAC standards drive best practices in the healthcare industry, encourage the improvement of service quality, and protect and empower patients by evaluating our business's risk management, operations, and infrastructure, as well as continuously monitoring and optimizing our performance. This accreditation is a guarantee of compliance with the highest and strictest standards and quality measures.

​

Accreditation Commission for Health Care, Inc. (ACHC)

​

ACHC is an independent organization that, through its accreditation, validates that the policies, processes, and delivery of healthcare services meet recognized quality and safety standards. This is verified through a comprehensive, multidisciplinary evaluation process. Within this accreditation are Accreditation Distinctions, which are based on a specific review and evaluation of a specialized service offered by an ACHC-accredited healthcare organization, measured against recognized standards of excellence in that specialty area.

​

The Joint Commission

​

In collaboration with pharmaceutical industry experts, The Joint Commission establishes relevant performance guidelines that drive sustainable improvements in patient safety, quality, and operational reliability. Its standards comply with regulatory guidelines and address key focus areas in the industry, such as medication reconciliation, patient-medication interaction, and the timeliness of therapy administration. The standards are applied appropriately based on the specific services. Pharmacy accreditation falls under the Home Care Accreditation Program, which covers both home and community-based service providers and pharmacies.

​

To ensure the highest level of excellence and commitment to our patients, we have a robust portfolio of accreditations that support the quality and safety of our services.

​

Our Accreditations

​

  • Alivia Specialty Pharmacy holds accreditations from URAC as a specialty pharmacy and from ACHC as a specialty pharmacy, with a distinction in oncology.

  • Alivia Infusion Services holds ACHC accreditation as a specialty and infusion pharmacy.

  • Farmacias Plaza 12 holds Joint Commission accreditation for durable medical equipment (DME's).

​

Your Opinion Helps Us Improve

​

It is essential for us to know your opinion, as it helps us continuously improve the quality of our services and ensure that we meet your needs in the best possible way. To this end, we have implemented a satisfaction survey designed to gather your valuable feedback and gain a deeper understanding of your expectations and experiences with Alivia Health. Your responses are crucial for optimizing the safety, efficacy, and efficiency of the services, products, and medications we offer you. Patient Survey

NOTICE OF PATIENT RIGHTS UNDER THE NO SURPRISES ACT

(Effective under federal law 45 C.F.R. §â€¯149.430) 

The No Surprises Act protects you from unexpected medical bills when receiving certain healthcare services, including pharmacy services. These protections apply if you are enrolled in a group health plan, individual or family health insurance coverage, or the Federal Employees Health Benefits (FEHB) Program, as well as uninsured individuals and people paying out of pocket for their pharmacy services.  

​

What is "Surprise Billing"? 

​

A surprise bill occurs when you receive a service or prescription from an out-of-network provider without your knowledge, and you are charged more than expected. This can happen during emergency care or when receiving services at an in-network facility from an out-of-network provider. Under the No Surprises Act, you are protected from being billed more than you’re in-network cost-sharing amount (e.g., copayment, coinsurance, deductible) in certain situations. 

​

You have the right to get care without surprise pharmacy bills. 

​

This Act protects you from surprise balance billing in the following scenarios: 

​

  • Emergency care: If your medication or service is part of an emergency treatment, you can’t be charged more than your insurance plan’s in-network rate even if we are not in your insurance network. 

 

  • Non-emergency care at an in-network location: If you get services at an in-network location (like a hospital or clinic), and someone involved in your care (like a lab or pharmacy) is out-of-network, you cannot be charged more than in-network rates unless you are notified and provide the authorization. 

 

  • Uninsured or cash-pay patients: If you don’t have insurance or choose not to use it, you have the right to get a Good Faith Estimate in writing before we process your prescription. This estimate provides a breakdown of the prescription cost. If your final bill is $400 or more over the estimate, you may be able to dispute it. 

​

What does this mean for our pharmacy? 

​

Alivia Health is committed to full compliance with the No Surprises Act and all applicable federal regulations. We have implemented procedures to ensure you are informed of your rights and protected from unexpected (or “balance”) billing. As part of our commitment: 

​

  • We will always attempt to process your prescriptions using your insurance at in-network rates. 

  • If a prescription is not covered or must be billed out-of-network, we will inform you of your options before processing the prescription.  

  • You will not be charged more than your in-network cost share unless you are notified in advance and provide consent. 

  • Upon request, by phone, or in writing, we can provide a Good Faith Estimate of expected charges.  

​

What if you think a billing mistake was made? 

​

If you identify a discrepancy on the services billed, you can contact our Revenue Cycle Management (RCM) Department by calling phone: 787-925-1989 or 1-888-925-1989.  

​

Additionally, if you would like to dispute a charge, you can file a complaint with our Quality and Compliance Department: 

​

Phone number: 787-709-4208 

Mail: P.O. BOX 246 Bayamón, Puerto Rico 00960 

Email: complaints@aliviahealth.com  

Website:  https://www.aliviahealth.com/compliance   

Online Form:   

https://secure.compliance360.com/ext/uUDPuYkRH_qKmniO6ttBfg==   

Confidential reporting site: aliviahealth.ethicspoint.com    

Puerto Rico Confidential Hotline Number: 833-407-9028

NOTICE OF NONDISCRIMINATION

THIS NOTICE INFORMS INDIVIDUALS ABOUT NONDISCRIMINATION AND ACCESSIBILITY REQUIREMENTS AND NONDISCRIMINATION STATEMENT:

Alivia Health Network and its affiliated companies (“we”, “us”, “our”) are committed to providing high-quality care to everyone we serve respectfully, equitably, and without discrimination. Our organization values the diversity of our community and works together to ensure that all individuals have equal access to our services, regardless of their background, language, ability, or identity. 

 

This notice is provided in accordance with Section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. § 18116) and its implementing regulations found at 45 C.F.R. Part 92, as amended by the 2024 Final Rule. Alivia Health Network must comply with the terms of this notice. However, we reserve the right to modify our practices and the terms of this notice. If we make any significant changes to our practices, we will update this notice and notify all active patients and/or clients. A copy of this notice will also be available upon request.  

 

This notice applies to all Alivia Health Network subsidiaries: 

  • Alivia Health Management (AHM)  

  • Alivia Home Delivery (AHD)  

  • Alivia Infusion Services (AIS)  

  • Alivia Pharmaceutical Services (HUB)  

  • Alivia Specialty Pharmacy (ASP)  

  • Farmacias Plaza (AFP) 

 

Notice effective date: July 01, 2025. 

 

Discrimination is Against the Law: 

​

Alivia Health does not discriminate on the basis of race, color, national origin, sex (including pregnancy, sexual orientation, and gender identity), age, or disability in its health programs and activities, in accordance with Section 1557 of the Affordable Care Act and other applicable federal civil rights laws. We are committed to ensuring that all individuals have equal access to services, free from discrimination based on these and other legally protected characteristics, such as religion, health status, or socioeconomic status, to the extent required by law. 

 

 Our Organization:

 

  • Provides people with disabilities, reasonable modifications and free appropriate auxiliary aids and services to communicate effectively with us, such as: 

  • Qualified sign language interpreters. 

  • Written information in other formats (large print, audio, accessible electronic formats, other formats). 

  • Provides free language assistance services to people whose primary language is not English, which may include: 

  • Qualified interpreters. 

  • Information written in other languages. 

  • If you need reasonable modifications, appropriate auxiliary aids and services, or language assistance services, you may contact the Quality and Compliance Director, who has been designated by our organization as the appointed resource to carry out the responsibilities of the Section 1557 Coordinator: 

​

Name: Leisvelvet Vega Santos 

Contact Information: Alivia’s Compliance Director  

Phone: 787-709-4208 

Email: cumplimiento@aliviahealth.com 

 

If you believe that Alivia Health has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a complaint in person or by mail, fax, or email with the Quality and Compliance Department at any of the following: 

​

Department Name: Quality and Compliance Department (Q&C)  

Phone number: 787-709-4208 

Mail: P.O. BOX 246 Bayamón, Puerto Rico 00960 

Email: complaints@aliviahealth.com 

Website:  https://www.aliviahealth.com/compliance  

Online Form:   

https://secure.compliance360.com/ext/uUDPuYkRH_qKmniO6ttBfg==  

Confidential reporting site: aliviahealth.ethicspoint.com   

Puerto Rico Confidential Hotline Number: 833-407-9028 

Mobile Intake Site QR code:

QR Code No Discriminacion

If you require assistance filing a complaint, our department representatives are available to assist you.  

​

Other resources available to file complaints: 

​

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically or in writing at the following: 

​

Office for Civil Rights Complaint Portal: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf  

Phone: 1-800-368-1019, 800-537-7697 (TDD) 

Mail: U.S. Department of Health and Human Services 

200 Independence Avenue, SW 

Room 509F, HHH Building 

Washington, D.C. 20201  

Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html  

 

You may also file a complaint with the following agencies:  

​

Puerto Rico’s Department of Health: 787-765-2929 

Patient Advocate Office: 787-977-1100 (metro area), 1-800-981-0031 

Medicare: 1-800-833-0356 

Disability Attorney: 787-725-2333, 787-725-4014 (TAD), 1-800-981-4125 (Toll free) 

Ombudsman for People with Disabilities: 787-725-2333 

 

 

This notice is available at Alivia Health website: https://www.aliviahealth.com.

Alivia Health values every one of our patients. If we have failed to provide anything but the highest quality of care, please complete this form and mail to the address above. If you prefer to discuss this further, please call us at (787) 709-4208. 

Footer.png

NEED HELP?

Our experts are available to answer all of your questions. Please send us a message so we can further assist you.

bottom of page