03/18/2024
Health Alliance Plan
Health Alliance Plan Managed Care Committee Member
April Danish, CHONC - Newland Medical Associates
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
Optum, Change Healthcare, and Their Affiliates Known and Published Outage!
Currently, Optum, Change Healthcare and their affiliates are experiencing a network interruption and therefore the following are impacted and are not available currently.
- 834
- 835
- 837
- Eligibility verifications though 270/271
We will notify you when transactions can resume.
Online Prior Authorization Requests
The current outage noted above does not affect our online prior authorization application, CareAffiliate, which IS available.
If your facility is unable to access CareAffiliate due to your own provider outage, please use the phone numbers below:
| For | Contact |
| Non-behavioral health emergent medical inpatient admission requests |
• Fax (313) 664-5914 (preferred) • Call Inpatient Admissions at (313) 664-8833, option 3 |
| Non-behavioral health prior authorization requests (pre-certified inpatient admissions, elective outpatient procedures, DME) |
• Fax (313) 664-5916 (preferred) • Call our RMT at (313) 664-8950, option 1 |
| Medical drug prior authorization requests |
• Fax (313) 664-5338 |
| Behavioral health prior authorization inpatient or outpatient requests |
• Fax (313) 664-8686 • Call CBHM at (800) 444-5755 |
| HAP Commercial and DSNP post-acute requests (LTACH/IRF/SAR) |
• Fax (313) 664-5820 • Call (313) 664-8800 |
Claims Processing for Pay Date Feb. 27 (Commercial and Medicare HMO and PPO Claims)
Feb. 26
Claims received prior to the Change Healthcare outage will be processed and remitted as follows:
- Payments will be rendered via normal processing (e.g., check or EFT).
- Remittance Advice documents are available when you log in at hap.org. If you need help with your username or password, just use the “forgot username” or “forgot password” buttons.
Reminder! Currently, Optum, Change Healthcare and their affiliates are experiencing a network interruption and therefore the transactions below are impacted and are not available currently.
- 834
- 835
- 837
- Eligibility verifications though 270/271
This message does not apply to HAP CareSource.
Availity As Temporary Clearinghouse Available During Change Healthcare Outage
March 6, 2024
During the Change Healthcare outage, HAP is partnering with Availity EDI Clearinghouse to accept 837 electronic submission of your HAP Commercial and Medicare Advantage claims (Payer ID 38224). Please note:
- If you are currently connected to a clearinghouse other than Change Healthcare, you will not need to make any changes for HAP to begin receiving your claims from Availity.
- Availity will notify their network of trading partners that HAP claims should be directed to Availity.
- We anticipate that you will be able to resume HAP claim submissions by the end of this week. We will be issuing an announcement in the days ahead when the connection with Availity is active.
- This transition to Availity is temporary and will continue throughout the Change Healthcare outage. During this temporary transition to Availity, you will not receive an 835 electronic remittance advice. However, you can still obtain this information from the provider HAP portal. Simply, log in at hap.org and select Remittance Advice.
If you only submit claims through Change Healthcare, you will need to connect to an alternative clearinghouse. If you are interested in establishing a connection with Availity, you can find more information here.
Continue to watch the HAP Provider Newsroom for information about the Change Healthcare outage and future announcements regarding our reconnection to Change Healthcare following the outage.
Note: This communication does not apply to HAP CareSource Medicaid and MI Health Link. It only applies to claims submitted to Payer ID 38224.
Availity Ready To Accept Claims As Temporary Clearinghouse Available During Change Healthcare Outage
March 8, 2024
Effective March 8, Availity EDI Clearinghouse is ready to accept 837 electronic submission of your HAP Commercial and Medicare Advantage claims (Payer ID 38224). Please remember:
- If you are currently connected to a clearinghouse other than Change Healthcare, you will not need to make any changes for HAP to begin receiving your claims from Availity.
- Availity will notify their network of trading partners that HAP claims should be directed to Availity.
- This transition to Availity is temporary and will continue throughout the Change Healthcare outage. During this temporary transition to Availity, you will not receive an 835 electronic remittance advice. However, you can still obtain this information from the provider HAP portal. Simply, log in at hap.org and select Remittance Advice.
If you only submit claims through Change Healthcare, you will need to connect to an alternative clearinghouse. If you are interested in establishing a connection with Availity, you can find more information here.
Continue to watch the HAP Provider Newsroom for information about the Change Healthcare outage and future announcements regarding our reconnection to Change Healthcare following the outage.
Note: This communication does not apply to HAP CareSource Medicaid and MI Health Link. It only applies to claims submitted to Payer ID 38224.
Reminder! Prior Authorization Requirements and Benefit Coverage Policy Updates
As you know, you can find our prior authorization requirements and benefit coverage policies
online. To access the lists, please follow the instructions below.
Prior Authorization Requirements
- Log in at hap.org
- Select Quick links
- Select Procedure Reference Lists
You can easily search by code to see if an authorization is required. To see changes from the
previous month, refer to the Summary of Changes.
Benefit Coverage Policies
- Log in at hap.org
- Select More
- Select Benefit Admin Manual
You can easily search for policies by a term, code, or phrase. To see changes from the
previous month, select Recent Changes.
Reminder! 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 full Medicaid benefits. Our plan is available for individuals who reside in Genesee, Macomb, Oakland and Wayne counties.
DSNP Provider Network
Providers contracted with HAP Medicare HMO products are participating in our D-SNP network. Members may only see providers in our D-SNP network. 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.
Model of Care Training Requirement
Per The Centers for Medicare & Medicaid Services contracted and non-contracted providers who see HAP Medicare Duals (HMO D-SNP) beneficiaries on a regular basis are required to take our model of care training initially and annually. There are two ways to take our model of care training.
- 1. Log in at hap.org
• Refer to the alert and click on “check your profile here.”
• Click on “HAP Medicare Complete Duals (HMO D-SNP)”
• There will either be a link to the training deck or a note that training has already been completed. - Visit www.hap.org/providers/provider-resources/medicare-101
• Review the HAP Medicare Complete Duals (HMO D-SNP) Model of Care Training.
• Complete the HAP Medicare Complete Duals (HMO D-SNP) Model of Care Training Attestation and follow the submission instructions.