11/13/2023
Health Alliance Plan
Health Alliance Plan Managed Care Committee Member
April Danish, CHONC - Newland Medical Associates
New Process to Verify Payments to Contracted Facilities Coming Soon!
To ensure high-quality claims processing and payment, HAP is taking additional steps to verify the accuracy of payments made to contracted facilities.
Effective February 1, 2024, we will begin performing cross-claim clinical reviews based on the member’s episode of care. Initially, medical records will not be required. Cotiviti, one of our audit vendors, will perform the review.
If you have claims selected for review, Cotiviti will send you a letter with the results. If necessary, you will have the opportunity to dispute any findings and can submit medical records at that time.
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
Payer ID Changes for Medicaid and MI Health Link Claims
On October 1st, HAP and CareSource officially partnered to bring HAP CareSource to Michigan. HAP Empowered Medicaid plans became HAP CareSource plans. HAP Empowered MI Health Link plans will become a HAP CareSource plan on January 1, 2024.
Important!
- The payer ID (38224) for HAP Commercial and Medicare plans is not changing.
- Submit Medicaid claims with dates of service prior to Oct. 1, 2023 to HAP Empowered Medicaid.
- Submit Medicaid inpatient claims with dates of service on or after Oct. 1, 2023 to the new Medicaid payer ID MIMCDCS1.
- Submit MI Health Link claims with dates of service prior to Jan. 1, 2024 to HAP Empowered MI Health Link.
- Submit MI Health Link inpatient claims with dates of service on or after Jan. 1, 2024 to the new MI Health Link payer ID MIMCRCS1.
- Inappropriate claims submitted to the new payer ID will be rejected as either incorrect payer or as a member eligibility error