10/15/2024
Health Alliance Plan
Health Alliance Plan Managed Care Committee Member
April Danish, CHONC - Newland Medical Associates
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 - 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.
- 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.
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