09/11/2024

Health Alliance Plan

Health Alliance Plan Managed Care Committee Member

April Danish, CHONC - Newland Medical Associates

Updated - Billing for Medicare Advantage Members in a Hospice Coordination Period
Medicare provides coverage for members during a hospice coordination period. A hospice coordination period is elected by the member and terminates when the member is discharged alive from the hospice or revokes the election of the hospice services.

HAP follows The Centers for Medicare & Medicaid Services (CMS) guidelines for determining the responsible payer per the CMS Medicare Managed Care Manual, Chapter 4, Section 10.4.

We also follow CMS payment guidelines which can be found in the:
• CMS Medicare Managed Care Manual, Chapter 8, Section 70.3.
• CMS Medicare Claims Processing Manual, Chapter 11, Section 30.4.

Reminder – Important Contacts to Help You
It can be frustrating to reach the wrong department when you are trying to resolve an
issue or obtain information. To ensure you get in touch with the right team, we have
resource to help you! Please see details below.

• • Visit hap.org/providers/contact-info. There is contact information for:
  • Claims, EDI and remittance advice
  • Eligibility, benefits and cost share
  • Authorizations
  • Demographic changes
  • Contracting and credentialing
  • Education and Training
  • And more!
• Log in at hap.org and select Important Contacts for Providers under Quick Links
  for:
  • Your HAP representative by network

For your convenience, important contacts can be found here (page 2).

Reminder – Prior Authorization Requirements, Benefit Coverage Policy Updates, and Pharmacy Information
As you know, you can find our prior authorization requirements, benefit coverage policies, and pharmacy  information online. Please follow the instructions below.

Prior Authorization Requirements

• Log in at hap.org
• Select Quick links
• Select Procedure Reference Lists

You can easily search by code to see if an authorization is required. To see changes from the previous month, refer to the Summary of Changes.

Benefit Coverage Policies

• Log in at hap.org
• Select More
• Select Benefit Admin Manual

You can easily search for policies by a term, code, or phrase. To see changes from the previous month, select Recent Changes.

Pharmacy Information

• Formularies can be found at www.hap.org/providers/provider-resources, then select Formularies and the appropriate list.
• For prior authorization requirements, log in at www.hap.org and select Quick Links, Procedure Reference Lists.
• Pharmacy policies and procedures can be found when you log in at www.hap.org, select Resources, Working with HAP, Policies and Procedures.

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