HAP Empowered health plan providers
Thank you for being a provider with HAP Empowered Health Plan, Inc. We appreciate the care that you give to HAP members with Medicaid and MI Health Link coverage.
With that in mind, we want to make it easy for you to do business with us. In this section, you’ll find numerous resources here that will help you serve our members.
We offer the following plans:
- HAP Empowered Medicaid
- HAP Empowered Healthy Michigan Plan
- HAP Empowered MI Child Program
- HAP Empowered Children’s Special Health Care Services program
- HAP Empowered MI Health Link
The Provider Manual will guide you through the important administrative items you need to know to manage your partnership with HAP Empowered such as:
- Billing requirements
- Appeals and grievance information, such as:
- Process and timeframe for peer-to-peer discussions
- Process for claim and authorization disputes
- Timelines for submitting appeals
- Timelines for our responses
- Process for rapid dispute resolution and binding arbitration
- Pharmacy information
- And more
This manual is reviewed annually and updated throughout the year as necessary.
Protecting patients and providers
HAP adopts and supports clinical practice or care guidelines for the treatment of a variety of medical and behavioral conditions. Care Guidelines help caregivers provide the right care at the right time using the most current evidence to result in the best outcomes. HAP’s clinical and medical policy team continue to evaluate scientific data, published evidence, and directives from trustworthy health care organizations to promote and establish clinical guidelines. These guidelines are used in combination with your clinical judgement and knowledge as a physician.
These guidelines are researched, developed, and approved in partnership with the http://www.mqic.org/. HAP is a key participant in the Michigan Quality Improvement Consortium (MQIC)— an organization of health plans focused on the health of our members in Michigan. MQIC is led by physicians and other clinical team members who evaluate scientific data and develop guidelines to help support the work of primary care physicians. MQIC’s goal is to standardize these practice guidelines to help all physicians in Southeast Michigan; and HAP is helping these efforts. MQIC review the guidelines every two years or as needed. For more information, see the guidelines here.
HAP’s medical director team continually evaluates the clinical guidelines established by the nation’s most prominent primary care and value-based associations to promote guidelines that support the overall physical and mental health of our members. Below are several of the organizations that our clinical teams review in order to promote the most updated clinical practice guidelines to promote healthy outcomes for HAP members:
- To help patients engage their health care provider in these conversations and empower them to ask questions about what tests and procedures are right for them, patient-friendly materials were created based on the physician association lists of recommendations of appropriate tests and treatments.
- Helpful materials on healthcare for Children from the American Academy of Pediatrics, the largest physician organization dedicated to the health of children
- Clinical Practices Guidelines, based on updated evidence to inform clinicians in the delivery of adult care from the American College of Physicians, the largest physician association of physicians who care for adults.
- Clinical Practice Guidelines from the American College of Obstetricians and Gynecology, the largest physician organization dedicated to women’s health and well-being:
- Clinical Practice Guidelines from the American Academy of Family Physicians, one the largest physician organizations focused on primary care for the entire family:
-Choosing Wisely: https://www.choosingwisely.org/patient-resources/
-Patient Care Materials from American Academy of Pediatrics:https://www.aap.org/en/patient-care/
-Clinical Guidelines and Recommendations: https://www.acponline.org/clinical-information/guidelines
-Clinical Practice Guidelines: https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline
-Clinical Practice Guidelines: https://www.aafp.org/family-physician/patient-care/clinical-recommendations.html
HAP Empowered does not require referrals to see an in-network specialist. The specialist may require a referral from the member’s PCP. Some services and procedures require prior authorization. Referrals and prior authorizations must be obtained prior to services being rendered.
Urgent requests should be marked urgent. Urgent requests will be accepted when the member or their physician believes waiting for a decision under the standard time frame could place the member’s life, health or ability to regain maximum function in serious jeopardy. Referrals and prior authorization for services should be made to in-network providers whenever possible. Contracted providers can be found in our online provider directory.
To refer a member to an out-of-network provider, please contact our Referral Management department at (313) 664-8950.
For a complete list of services that require authorization, log in and select Procedure Reference Lists under Quick Links.
To learn more about the step in the prior authorization process, see the Referrals and Authorizations section in the Provider Manual.
Below you will find important news and updates from HAP Empowered. For the most up-to-date MDHHS resources, including the Medicaid Provider Manual, Michigan Medicaid Proposed Policies, Michigan Medicaid Approved Policy Bulletins and Numbered Letters, click here. You will also find a link to subscribe to the MDHHS Michigan Medicaid listserv to receive Medicaid final bulletins.