HAP Primary Choice Medicare (HMO)

Thank you for being a provider of HAP Choice Medicare (HMO). Since its inception, HAP and Affinia have been working together to ensure a smooth launch.

We’ve listened to your concerns and we’re committed to partnering to remove barriers and undue administrative burden. We all want to ensure these members have easy access to the care they need. As such, we’re implementing the changes below, effective retroactively to January 1, 2020.

Referral requirements

  • Referrals are not required in HAP’s online referral and authorization system, CareAffiliate for in-network care. The PCP remains the member’s key partner in managing care; please continue to manage referrals in Epic or GLHC.
  • Referrals are required for out-of-network care (excluding emergencies, urgent care, dental, vision, and dialysis). HAP Choice PCPs will continue to enter these referrals in CareAffiliate.

Prior authorization requirements

Prior authorization is required for a limited set of codes, inpatient admissions and neuro/psych testing. The ordering provider can enter these prior authorizations in CareAffiliate.

Out of state care

The travel benefit no longer requires a referral or a prior authorization. Members are required to call HAP customer service at 866 766 4714 (TTY: 711) to activate their travel benefit. This benefit includes extended trips to Arizona, Florida, or Texas, as well as northern Michigan. Members will receive a case number to share with their provider.

Network Care Coordination Ratio (CCR) Reporting

In addition, HAP will further support management of the HAP Choice narrow network by building out reporting that supports the CIN’s ability to provide information, updates, and education surrounding this product’s narrow network prerequisite:

  • A daily report of out-of-network referral data to allow for member redirection as appropriate, as well as identify network servicing gaps.
  • A daily inpatient census report to allow for the redirection of follow up care when a member is hospitalized out of network.

HAP systems have been updated to account for these new guidelines. Claims are being processed; there is no need to resubmit.

We value our relationship with you and the quality of care and service you provide to HAP Choice Medicare (HMO) members. HAP is committed to building a highly engaged provider network in part by providing you with exceptional customer service.

We are interested in your feedback, questions, or concerns as we continue this new product rollout. Please do not hesitate to reach out to your Affinia Network Relation Specialist at affinianetworkrelations@mercyhealth.com for any assistance.

Download CareAffiliate Directions
3 Responses
  1. KELLY

    JUST CONFIRMING WITH YOU…
    SHORELINE FOOT AND ANKLE ASSOC. (CONTACT IS KELLY JANUSKA)

    WE REC’D 3 CLAIM DENIALS ON OUR FEB. 4, 2020 REMITTANCE ADVICE, STATING NO PAYMENT DUE TO NO AUTH ON FILE….

    ARE WE TO ASSUME THAT HAP WILL CATCH THESE AND RECONSIDER THESE FOR PAYMENT?

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