06/14/2024

Health Alliance Plan

Health Alliance Plan Managed Care Committee Member

April Danish, CHONC - Newland Medical Associates

Pre-Service, Post-Service, and Urgent Prior Authorization Requests
Please see the instructions below for submitting pre-service, post-service, and urgent authorization requests.

Pre-service
The prior authorization request is being created today and services are starting today or any day after today.

Post-service
The prior authorization request is being created today; however services started yesterday or any day prior to today. 

Urgent
Per the Centers for Medicare & Medicaid Services, when applying the standard timeframe could seriously jeopardize the life or health of the enrollee or the enrollee’s ability to regain maximum function.

Important! Please do not mark prior authorization requests for services that have already started or
rendered as “urgent.” They will be processed as post-service requests.

Change Healthcare Claims Services Restored
May 10, 2024

Effective immediately, Change Healthcare is processing electronic remittance advice (835s). You should already be receiving your 835 files dated back to February 20, 2024. 

HAP has also reconnected to Change Healthcare (CHC) to receive 837 files directly from CHC, in addition to Availity. This should not require any changes to your processes at this time.

Reminder – Online Provider Resources
Here are some of the helpful resources you can find on www.hap.org/providers - no need to log in!

• Admission & Transfer On-Call Schedule
• After Hours Standards and Appointment Time Access Standards for Primary Care, Behavioral Health and High-Volume, High-Impact Specialists
• Clinical practice guideline information
• Facility Standards for Practitioners and Providers
• Inpatient rehab and skilled nursing facility forms
• Medical Record Standards for Practitioners and Providers
• Provider Change Form to update your existing practice information

Resources for Medicaid and MI Health Link business can also be found online. Visit www.hapcaresource.com for:

• Provider Manual
• Member rights and responsibilities
• Appeals and grievance information
• Billing requirements
• Prior authorizations
• Clinical practice guidelines

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 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.

Pharmacy Information

• Formularies can be found at https://www.hap.org/providers/provider-resources,
  then select Formularies and the appropriate list.
• For prior authorization requirements, log in at 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.