01/17/2023
Health Alliance Plan
Health Alliance Plan Managed Care Committee Member
April Danish, CHONC - Newland Medical Associates
HAP and MSU Health Care Introduce Co-Branded Medicare Advantage Plan
Versatile HMO is available in 46 counties with access to HAP’s full HMO network of 50,000 providers
HAP and MSU Health Care have introduced a co-branded Medicare Advantage plan, the HAP MSUHC Medicare HMO. Available to any Medicare-eligible individual, the plan offers access to HAP’s full network that includes more than 50,000 providers throughout Michigan.
Here are some highlights of the plan:
- $0 premium
- $0 primary care provider (PCP) copay
- $0 copay on mental health visits
- Dental benefit with a $3,000 maximum coverage allowance that includes extractions
- A $500 flex card that includes funds for two categories of benefits:
- $200 can be used toward dental, vision and hearing
- $300 can be used toward companion care, a personal emergency response system (PERS), transportation and over-the-counter items
- And much more
The HAP MSUHC Medicare HMO is the first joint product offered by HAP and MSU Health Care following our announcement in 2021 that we were joining forces to improve senior health across the state.
As a valued partner, we wanted to make you aware of this exciting new product.
Introducing Dx Gap Advisor ™
As the healthcare industry faces unprecedented change, HAP is focused on helping providers manage operations and address proper claims submission within their existing workflow.
We have partnered with Change Healthcare to implement Dx Gap Advisor, a solution designed to ensure complete and accurate claims and alert providers when diagnosis codes are potentially missing from a claim. We plan to implement this solution early next year.
Below is a high-level overview of the process:
- Automated messages are triggered on claims that may be incomplete or inaccurate for patients with historic claims data (e.g., evidence of an established diagnosis of a chronic condition missing on the current claim)
- Messages are returned via the standard EDI 277CA transaction which fits into the existing claims workflow process
- Providers have three options to address the alert:
- Ignore it and make no changes to the claim and then resubmit the claim using the original claim ID
- Include additional supported diagnosis codes on the claim and then resubmit the claim using the original claim ID
- Remove non-supported diagnosis codes on the claim and then resubmit the claim using the original claim ID
We are confident this process will deliver complete and accurate claims the first time around. In addition, it could also result in fewer medical record requests in the future.
For more information on Dx Gap Advisor, watch the provider newsroom for updates.