12/16/2024

Health Alliance Plan

Health Alliance Plan Managed Care Committee Member

April Danish, CHONC - Newland Medical Associates

Multifactor Authentication (MFA) Coming Soon!
In early 2025, HAP will be implementing multifactor authentication (MFA) to access the secure provider portal. Users will be required to authenticate either by text message, phone call, email,l or an authenticator app.

Watch the provider newsroom for details!

HEDIS MY 2024 Medical Record Review Project Coming Soon!
The HEDIS® medical record review process is an annual retrospective process. It’s an integral part of HAP’s HEDIS reporting process. It involves the collection and review of medical records to assess the quality of care provided to our members and your patients.

Our HEDIS® medical record review process will begin in early February 2025 and proceed through early May 2025. We have contracted with Cotiviti, Inc. to retrieve medical records and perform HEDIS medical record data abstraction on our behalf.

• Cotiviti, Inc is ethically and legally bound to protect, preserve, and maintain the confidentiality of any protected health information (PHI) it gleans from clinical records provided by medical practice locations pursuant to its contractual obligations to HAP defined by the Health Insurance Portability and Accountability Act (HIPAA).
• Please be assured Cotiviti will treat your patients’ PHI with the utmost protection and confidentiality.

Cotiviti will contact your office to request copies of chart components. There will be instructions for submitting the data via fax, mail, or an electronic link. They will work with you to try to minimize disruptions to your day-to-day operations as much as possible.

Cotiviti will provide their contact information should you have any questions regarding the requested information or data collection process.

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

Update - HAP CareSource Marketplace Plans Coming in 2025 – Claims Information
November 22, 2024

Effective January 1, 2025, HAP CareSource will offer Marketplace plans in Michigan. They are available in Genesee, Lapeer, Macomb, Oakland, Shiawassee, and Wayne counties. These plans are on-exchange and have gold, silver, and bronze tiers. There are also chronic-condition health plans:

• Diabetes (gold and silver)
• Healthy Heart (gold and silver)
• HDHP Preventive and Preventive (silver)

Important!
These plans are Commercial HMO. If you are participating in HAP HMO Commercial plans, then you are participating in the HAP CareSource Marketplace plans.

READ MORE 

Reminder – Benefit Policies, Prior Authorizations, and Pharmacy Information
Please see below for helpful reminders and tips!

Benefit Coverage Policies
Log in at hap.org, select More, Benefit Admin Manual. You can easily search for policies by term, code, or phrase. To see changes from the previous month, select Recent Changes.

Prior Authorizations
Requirements
Log in at hap.org, select Quick Links, 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.

Electronic Submission Requirement
Per Michigan Senate Bill 247, health care providers are required to submit prior authorization requests electronically. Faxes are not allowed. While this requirement is specific to members in commercial plans, you should submit requests electronically for members in all HAP plans. It’s the most efficient process! You can find our online application, CareAffiliate, when you log in at hap.org and select Authorizations.

Help or access issues with online authorization application, CareAffiliate
Email providernetwork@hap.org and put “CareAffiliate help” in the subject line and be sure to include:

• Provider Name; NPI 1 and NPI 2 (if appropriate) and Tax ID

Requests to Non-Par Providers
You should always refer HAP members to HAP participating providers. You must obtain prior authorization to refer a HAP member to a non-participating provider. The reason for the referral is also required (e.g., second opinion; service is not available with a HAP par provider).

READ MORE