07/15/2024

Health Alliance Plan

Health Alliance Plan Managed Care Committee Member

April Danish, CHONC - Newland Medical Associates

Online Claims Appeals – New Status Reasons
We’ve updated our online claims appeal application with new status reasons to help you better understand our decision. Below you will find the new codes, descriptions, and next steps.

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Inpatient Admissions Criteria
Effective July 2, 2024, HAP will be transitioning to the latest version of the following
medical screening modalities:

• InterQual® 2024
• Centers for Medicare & Medicaid Services (CMS) Addendum E.-Healthcare
  Common Procedure Coding System (HCPCS) Codes That Would Be Paid Only as Inpatient Procedures for Calendar Year 2024
• HAP Criteria for Inpatient Admissions 2024 (attached)
• HAP Clinical Surgical Criteria 2024 (attached)

You can also find the CMS list and our criteria when you log in at hap.org and select Resources; Caring for Patients; HAP Criteria for Inpatient Admissions.

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Keep Provider Information Updated in NPPES
It’s important to ensure your data in the National Plan & Provider Enumeration System (NPPES) is accurate. The Centers for Medicare & Medicaid Services (CMS) is encouraging health plans to use NPPES as a resource for online provider directories. By using NPPES database for provider directories, we could decrease the frequency we contact you for this information.

To verify your information, log in at the NPPES website. When reviewing, pay close
attention to:

• Provider name
• Mailing address
• Telephone and fax numbers
• Specialty
• Taxonomy

Be sure to remove any practice locations no longer in use and only include addresses where:

• You practice
• You actively see patients
• Patients can call and make an appointment