04/12/2024

Health Alliance Plan

Health Alliance Plan Managed Care Committee Member

April Danish, CHONC - Newland Medical Associates

Update! Medical Record Review Projects (Vendor Updates)
HAP partners with vendors to conduct medical record reviews. They contact offices directly and
provide the review details, including due dates and submission requirements.

The table below outlines our current and upcoming medical record review projects. All reviews
are conducted by our vendor, Optum/Episource, LLC unless otherwise noted. Provider offices
could be contacted more than once due to different regulatory projects, dates of service, and
membership.

READ MORE 

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 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.