08/18/2025

Health Alliance Plan

Health Alliance Plan Managed Care Committee Member

April Danish, CHONC - Newland Medical Associates

HAP CareSource Monthly Updates Posted July 2025 
Below are updates from the HAP CareSource Updates & Announcement page for each HAP CareSource
plan.

• HAP CareSource Marketplace  
  • Policy Updates for July 2025  
• HAP CareSource Medicaid  
  • Policy Updates for July 2025   
• HAP CareSource MI Health Link  
  • Policy Updates for July 2025  

Newsletter for all HAP CareSource Plans

• Summer 2025 ProviderSource Newsletter 

The HAP Pledge
HAP continually strives to ensure that its members receive all necessary services at the appropriate time and in the appropriate setting. Utilization management decision-making is based on the appropriateness of care and service and the existence of coverage. HAP does not reward practitioners or other individuals conducting utilization review for issuing denials of coverage or service. HAP does not offer financial incentives to encourage inappropriate underutilization of covered services.

To assist in the continual improvement of health care delivery, practitioners and physicians may obtain clinical criteria or discuss utilization management decisions. (Note: certain clinical criteria or guidelines may be applicable only to governmental programs or only to commercial plans). Criteria used in decision-making may include InterQual, HAP criteria, the HAP Benefit Administration Manual, eviCore healthcare criteria, pharmaceutical clinical criteria, national guidelines, landmark trials, peer-reviewed journal publications, Medicare national and local coverage guidelines, Medicare COMPENDIA such as DrugDex and American Hospital Formulary Service, medical resources such as UpToDate® and, at times, guidelines from other local/national health plans.

To discuss a utilization management decision or process with a physician reviewer or health care professional reviewer or to obtain a copy of the criteria used in the decision-making process, practitioners may contact HAP as outlined in the table below. Please have the member’s name and HAP ID number available to assist in accessing the case. HAP physician reviewers are board-certified and have current Michigan licenses to practice without restriction.

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Monthly Reminders
Below are several reminders related to our benefit coverage policies, pharmacy information, our preferred lab partner, updating your provider information, and prior authorization guidelines.

Appeals Information

• Appeals processes can be found online. Log in at www.hap.org and select Provider Manual under Quick Links.

Benefit Coverage Policies

• Log in at www.hap.org, select More, Benefit Admin Manual. You can easily search for policies by term, code, or phrase.
• To see changes from the previous month, select Recent Changes.

Clinical Practice/Care Guidelines

• HAP adopts and supports clinical practice or care guidelines for the treatment of a variety of medical and behavioral conditions. These guidelines are researched, developed, and approved in partnership with the Michigan Quality Improvement Consortium (MQIC). HAP is a key participant in MQIC and considers their guidelines.
• Care Guidelines help caregivers provide the right care at the right time using the most current evidence to result in the best outcomes. HAP’s clinical and medical policy team continue to evaluate scientific data, published evidence, and directives from trustworthy health care organizations to promote and establish clinical guidelines. These guidelines are used in combination with your clinical judgement and knowledge as a physician.
• You can find our guidelines online. Visit www.hap.org/providers, select Provider Resources, then Care Guidelines.

Pharmacy Information

• Prior authorizations – choose the correct Request Type in the online application
  
  • There are a few choices related to specific drugs. Otherwise, you need to select a “DRUG-General Request” and ensure you are choosing the correct location for administration (home infusion, infusion center, or office).
• Submitting Prior Authorization Requests for Part D Drugs
  • Electronically through CoverMyMeds: Helping People Get the Medicine They Need 
• Formularies: Visit https://www.hap.org/providers/provider-resources , select Formularies
• Policies: Log in at www.hap.org, select Resources, Working with HAP, Policies and Procedures.

Preferred Lab Partner

• Joint Venture Hospital Laboratories (JVHL) is a network of community hospital labs. JVHL offers lab services at most of HAP’s participating hospitals. HAP has an affiliation with JVHL as our preferred lab for Commercial HMO members. Providers are expected to use JVHL labs whenever possible. For more information on locations and services, please visit the JVHL website.

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