Complete Story
02/17/2025
Health Alliance Plan
Health Alliance Plan Managed Care Committee Member
April Danish, CHONC - Newland Medical Associates
Payment of Observation Hospital Stays
Per the HAP Medical Screening for Observation Services policy, observation stays of up to 48 hours will be reimbursed without prior authorization. Currently, HAP is adjusting the claims when the observation stay (revenue code 762) exceeds 48 hours.
Effective May 1, 2025, HAP will deny all services when the date(s) of services exceeds the 48-hour observation stay date range. Services include, but are not limited to labs, X-rays, pharmacy, etc.
This policy effects HAP Commercial, HAP Medicare Advantage and Alliance Health and Life plans.
Update - Medical Record Review Projects
HAP partners with vendors to conduct medical record reviews. They contact offices directly and provide the review details, including due dates and submission requirements.
The table below outlines our current and upcoming medical record review projects. All reviews are conducted by our vendors, Optum/Episource, LLC, Cotiviti and Reveleer unless otherwise noted. Provider offices could be contacted more than once due to different regulatory projects, dates of service, and membership.
Reminder: Ordering Genetic Tests for HAP Members
Henry Ford Center for Precision Diagnostics (HFCPD) at Henry Ford Hospital is HAP’s preferred provider for genetic and cytogenetic testing. This arrangement requires most genetic and cytogenetic testing (CPT ranges 81105-81364, 81400-81479 and 88230-88299) to be performed at HFCPD. Per HAP member benefit policies, tests within these CPT ranges which are performed elsewhere may or may not be reimbursed.
Most genetic tests require prior authorization. The following information may be helpful when genetic testing is being considered for HAP members.
Reminder - Multifactor Authentication (MFA) Coming Soon
Provider FAQs
In early 2025, HAP will require MFA to access the secure provider portal. Below is some helpful information about this implementation. The questions highlighted in orange below contain new or updated information since the last posting.
1. Why is HAP implementing MFA?
Added security for you and your HAP patients. MFA will also help with “forgot username” and “forgot password” functionality. You will be able to enter a code that is emailed to you or sent to your authenticator app instead of having to remember the answer to a challenge question.
2. When will MFA be implemented?
We anticipate go live in March 2025. Once MFA is live, the first time you log in you will have to enter a code that will be sent to your email address. After this initial authentication, you will be able to add either Microsoft or Google Authenticator as an option for future logins.
Reminder: New HAP 2025 Medicare Advantage Plans
HAP Medicare Advantage plans have access to an extensive network of doctors and hospitals across the state, 24/7 telehealth services, over-the-counter benefits, fitness options, and more. We have four new Medicare Advantage plans for 2025!
Report Broken Links
Have you encountered a problem with a URL (link) on this page not working or displaying an error message? Help us fix it!
