03/20/2026

[Duplicate] Health Alliance Plan

Health Alliance Plan Managed Care Committee Member

April Danish, CHONC - Newland Medical Associates

Changes for Specific J-Codes and Q-Codes Coming Soon

Prior Authorization for J9172 and J9174

Effective April 1, 2026, the codes below will require prior authorization for members in HAP Medicare Advantage plans, HAP Commercial plans and HAP Qualified Health Plans (off-exchange).

• J9172: Injection, docetaxel (ingenus) not therapeutically equivalent to J9171, 1 mg
• J9174: Injection, docetaxel (beizray), 1 mg

NOTE: J9171: Injection, Docetaxel, 1 MG is covered. No prior authorization is required

READ MORE

Clinical Trials Billing Requirements Coming Soon

Effective May 1, we will implement the billing guidelines below for items and services furnished to members enrolled in approved clinical trials. For HAP Commercial plans, routine patient care costs are covered as required under the Affordable Care Act (ACA). For HAP Medicare Advantage (MA) plans, coverage of routine costs follows Medicare rules. In qualifying clinical trials, Original Medicare (FFS) processes trial-related services, and the MA plan coordinates secondary cost-sharing. READ MORE

Sequestration Reduction

As a reminder, Medicare sequestration is addressed in HAP’s provider manual and applies to all HAP Medicare Advantage members and plans. HAP will continue to apply Medicare sequestration, please read more HERE

Reminder - Ordering/Referring Practitioner Billing Requirements

To ensure accurate claims processing, providers should include the National Provider Identifier (NPI) of the practitioner who ordered, referred, or directed the service when submitting claims for any service that originates from a clinical order, referral, or treatment plan. This requirement applies to all services initiated under the direction of another licensed practitioner. READ MORE