09/15/2025

Health Alliance Plan

Health Alliance Plan Managed Care Committee Member

April Danish, CHONC - Newland Medical Associates

Reminder - Claims Appeal Timeframe
Providers have 60 days from the date of the original claim denial to submit a valid appeal. Here is how you can find the denial date:

• On the remittance advice (RA).
• If you received an audit determination letter, the denial date is 60 days from the date of the letter, not the RA date.

You can also find a detailed explanation of the denial:

• On the RA.
• Online by logging in at www.hap.org, selecting Claims, and then the specific denied claim.
• By calling HAP Provider Inquiry at (866) 766-4661.

Any claim appeal submitted past the 60-day appeal timeframe will be closed. No review will be made. These denials cannot be billed to the patient.

You can find more information on the claims appeal timeframe in the HAP Provider Manual-Billing & Administrative Guide for Commercial & Medicare Advantage Plans.

Process Change When Providers Appeal On Behalf of a Member
Today, you might appeal a decision on behalf of your HAP Commercial patient, which could include attending a hearing to present the rationale on why we should overturn a denied decision.

Effective January 1, 2026, hearings for second-level appeals for HAP Commercial members will no longer be offered as part of our appeals process. This change will not affect your right to submit a second-level appeal, nor will it change the criteria or timelines for filing.

We will continue to send letters to members and providers when a provider is appealing on behalf of a member. The letter contains appropriate instructions on our process.

Medicare Fraud Scheme Involving Phishing Fax Requests
Below is an alert from The Centers for Medicare & Medicaid Services.

CMS has identified a fraud scheme targeting Medicare providers and suppliers. Scammers are impersonating CMS and sending phishing fax requests for medical records and documentation, falsely claiming to be part of a Medicare audit.

Important!
CMS doesn’t initiate audits by requesting medical records via fax. Protect your information. If you receive a suspicious request, don’t respond. If you think you got a fraudulent or questionable request, work with your Medical Review Contractor to confirm if it’s real.

Update - Henry Ford Infusion – Preferred Provider for Home Infusion of Specialty Medications for HAP Commercial Members
HAP Commercial members must receive specialty medications professionally administered at home from our preferred specialty provider - Henry Ford Home Infusion. Henry Ford Home Infusion (HFHI) will provide the specialty medication, as well as nursing services. We will contact members affected by this change. In certain circumstances, HFHI may refer your patient to an alternate HAP preferred home infusion service (e.g., AvevoRx or Access to Care).

Medications marked with SPC in the Key column on our Services that Require Prior Authorization List are specialty medications that may be available for home infusion. When submitting a request via our online authorization application for any HCPCS codes that are designated with SPC, you will be alerted that the medication must be provided by our preferred specialty provider.

If your patient is receiving specialty home infusion services, please complete the steps necessary to transition care to our preferred home infusion providers by October 30, 2025.

Please contact Henry Ford Home Infusion by phone at (248) 827-3370 or by fax at (248) 827-7234.

This change does not affect services administered in the clinic or infusion center. You can find the policy when you log in at www.hap.org and select Benefit Admin Manual under More.