05/13/2024
Health Alliance Plan
Health Alliance Plan Managed Care Committee Member
April Danish, CHONC - Newland Medical Associates
Two Midnight Rule Clarification
Per The Centers for Medicare and Medicaid Services 2024 Final Rule, Medicare Advantage Plans may still use prior authorization or concurrent case management review of inpatient admissions based on whether the complex medical factors documented in the medical record support medical necessity of the inpatient admission, under either the two midnight benchmark or the case-by-case exception. More information on the Final Rule can be found here.
HAP will continue to follow its medical screening for hospital admissions policy. You can find this policy online. Simply log in at www.hap.org; select Resources; Working With HAP; Policies and Procedures, then Medical Screening for Hospital Admissions under the Admissions & Transfers (Inpatient Services) section.
Reminder - 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
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 www.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 www.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.