08/19/2024
Health Alliance Plan
Health Alliance Plan Managed Care Committee Member
April Danish, CHONC - Newland Medical Associates
Important Information about HAP CareSource Medicaid
Please read our press release about HAP CareSource awarded expanded regions to provide Medicaid coverage in Michigan!
Remember, you can always find information about HAP CareSource when you visit www.hapcaresource.com, then select Providers.
Reminder – Prior Authorization Requirements, Benefit Coverage Policy Updates, and Pharmacy Information
As you know, you can find our prior authorization requirements, benefit coverage policies, and pharmacy information online. 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.
Pharmacy Information
- Formularies can be found at www.hap.org/providers/provider-resources, then select Formularies and the appropriate list.
- For prior authorization requirements, log in at www.hap.org and select Quick Links, Procedure Reference Lists.
- Pharmacy policies and procedures can be found when you log in at www.hap.org, select Resources, Working with HAP, Policies and Procedures.
Reminder – Submitting Urgent Prior Authorization Requests
Please do not mark prior authorization requests as “urgent” for services that have already started or been rendered. They will be processed as post-service requests.
Per the Centers for Medicare & Medicaid Services (CMS), urgent should only be used when:
- Applying the standard timeframe could seriously jeopardize the life or health of the enrollee or the enrollee’s ability to regain maximum function
Submission guidelines can be found here.
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