12/14/2023

Health Alliance Plan

Health Alliance Plan Managed Care Committee Member

April Danish, CHONC - Newland Medical Associates

HAP Commercial Formulary - Medical Drugs Buy and Bill Update
Buy-and-bill is a process for physician offices to acquire medications that providers can administer in the office. The “buy” part refers to providers who are responsible for ordering and purchasing the drug. The “bill” part refers to providers billing directly to third-party payers for reimbursement.

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Provider Transition Quick Reference Guide
To view the reference guide, click here. Below are the topics that are covered: 

• Important Contacts
• Contracting and Credentialing
• Resources for Providers
• Accessing Secure Provider Portals
• ID Cards
• Electronic Data Interchange (EDI) Information
• Member Eligibility and Benefits
• Prior Authorizations and Referrals
• Claims
• Remittance Advice
• Pharmacy
• Vendor Relationships

2024 HAP Medicare Advantage Plans and Benefits
Below are some changes in HAP Medicare Advantage plans and benefits effective January 1, 2024.

New plan names
Some of our current plan names are changing:

2023 ➜ 2024
HAP Senior Plus (HMO) ➜ HAP Medicare Connect (HMO)
HAP Senior Plus MA Only ➜ HAP Medicare MedicalAccess (HMO)
HAP Senior Plus (PPO) ➜ HAP Medicare Explore (PPO)

Extra benefits
Most of our plans include extra benefits such as:

• Dental
• Vision
• Hearing
• Telehealth
• Visitor/travel benefits
• Emergency travel protection
• Fitness benefits – available through SilverSneakers in 2024
• Over-the-Counter (OTC) benefit (yearly allowance for health and wellness items including healthy food items in 2024

Part D Insulin pricing – new for 2024!
Copays won’t be more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if the deductible is not met.

For more information on HAP Medicare Advantage plans and benefits, visit hap.org/medicare.

Reminder!
Be sure to always verify eligibility and benefits prior to services, especially in the new year. You can easily do this online. Just log in at hap.org.

Aspire Health is becoming Carelon Health
Today, we partner with Aspire Health for a special program that delivers home-based support for patients with an advanced illness.

Effective January 1, 2024, Aspire Health will become Carelon Health.

Although the name is changing, your patients will still receive the same care. Patient referrals and your professional relationships with clinical staff will not change. There’s nothing you or your patients need to do!

For more information about the program, please see the attached frequently asked questions.