05/20/2026

Health Alliance Plan

Health Alliance Plan Managed Care Committee Member

April Danish, CHONC - Newland Medical Associates

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

Reimbursement for G2211

Effective with dates of services on or after July 1, 2026, HCPCS code G2211 is only payable for HAP Medicare Advantage members when the service meets the billing guidelines and is supported in patient medical records. READ MORE

Update - Medical Record Review Projects

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. Unless otherwise noted, our vendors, Optum/Episource, LLC, and Cognisight conduct all reviews. Provider offices could be contacted more than once due to different regulatory projects, dates of service and membership. READ MORE

April 2026 Updates from HAP CareSource

Review recent updates relevant to HAP CareSource’s Michigan participating providers HERE

Monthly Reminders

For a listing of several resources to make it easier to do business with HAP CLICK HERE

CareSource Plans CLICK HERE

Prior Authorizations CLICK HERE

After Hours Survey Coming Soon!

Annually, we monitor compliance with our after-hours care standards. We contact offices of primary care physicians and behavioral health prescribers (e.g., psychiatrists) and non-prescribers (e.g., psychologists). Our study measures the member’s ability to reach a medical professional after the office is closed.

Contract Requirements

Per your HAP contract, PCPs, behavioral health providers or their designee are required to be available by phone 24 hours a day, seven days a week. Voicemail alone after hours is not acceptable. There must be a means to reach a live person.

Acceptable methods for compliance

To ensure compliance with our standard, your office must have one or more of the following:

• Automated message that includes an option to speak to or reach a physician.
• Recorded message with clear instructions for reaching provider or direct phone number of provider.
• Recorded message with an option to leave a number/message for an after-hours phone call from an appropriate practitioner. The message must indicate a timeframe when the member can expect the return call. Our standard is 60 minutes or less.
• Answering service with a live agent offering to speak with or be contacted by a physician.

Also, at the beginning of a recorded after-hours message, there must be instructions for patients with life-threatening conditions and separate instructions for urgent conditions. This includes calling 911 or going to the nearest emergency room.

Our standards can be found when you visit www.hap.org/providers/forms-documents