05/11/2023
Health Alliance Plan
Health Alliance Plan Managed Care Committee Member
April Danish, CHONC - Newland Medical Associates
HAP Medicare Complete Duals (HMO D-SNP) Annual Required Training
HAP Medicare Complete Duals (HMO D-SNP) is a dual special needs plan, or D-SNP. It’s a special type of Medicare Advantage HMO plan that provides health benefits to members who qualify for Medicare and are eligible for Medicaid services. Our plan is available for individuals who reside in Genesee, Macomb, Oakland and Wayne counties.
The primary care physician is not required to become a HAP Empowered Medicaid participating provider. The member cannot be held responsible for the remaining balance that Medicaid would cover. Providers contracted with HAP Medicare plans and open to new patients are required to see our D-SNP members.
For more information on this plan, visit hap.org/providers, Provider Resources, then Medicare 101.
Training Requirements Reminder
The Centers for Medicare & Medicaid Services requires D-SNP plans to:
- Have an approved model of care
- Annually, train providers on their model of care. All providers and office staff who interact with D-SNP members are required to complete training.
There are two ways to take our model of care training:
- Log in at hap.org. There will be a pop-up alert if training has not been completed. Simply click on the link, review the training and complete the attestation. If there is no pop-up alert, then the office has successfully completed training.
- Visit https://www.hap.org/providers/provider-resources/medicare-101
Appointment Time Standards Reminder
Per regulatory guidelines, HAP has established standards for appointment availability to ensure patients have timely access to care. HAP providers are required to adhere to our standards, per their contract.
There are standards for:
- Primary care
- Behavioral health
- High-volume specialists (at a minimum includes obstetrics/gynecology)
- High-impact specialists (at a minimum includes oncology)
- Top two specialties based on claims volume which can vary from year to year
Reminder – Prior Authorization Requirement Lists Updated Monthly
Our prior authorization requirements lists are updated monthly. A summary of changes from the previous month is also available. To access these lists:
- Log in at hap.org
- Select Quick links
- Select Procedure Reference Lists and refer to the appropriate list
Remember, there are many services and procedures that do not require prior authorization and it only takes a minute to check! When you open a list, you can search for a code by pressing the “ctrl” key and the letter F at the same time and entering a code in the search box.