HAP Midwest Health Plan providers
Thank you for being a provider with HAP Midwest 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.
Earlier this year, the plans we offer through HAP Midwest became HAP Empowered plans. These plans include:
- 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
Only our plan name changed. Members are still with HAP Midwest and their coverage didn’t change.
Your Provider Manual will guide you through the important administrative items you need to know to manage your partnership with HAP Midwest. In addition to providing an introduction to our plans, the manual covers the following topics:
- Network development and contracting
- Your HAP services
- Customer Service support
- Member eligibility and enrollment
- Referrals and authorizations
- HAP Empowered MI Health Link long-term services and supports
- Billing and reimbursement
- Claims and clinical appeals
- Pharmacy coverage
- Quality management
- Management and reporting for vaccines, MCIR and communicable diseases
- Continuity of care
- HAP Empowered MI Health Link model of care
- Philosophy of care
- Policies on privacy, whistleblower protection and fraud, waste and abuse
We adopt and support 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. These guidelines are used in combination with your clinical judgment and knowledge as a physician.
These guidelines are researched, developed and approved in partnership with the Michigan Quality Improvement Consortium. MQIC's goal is to standardize these practice guidelines to help all physicians in Southeast Michigan. HAP is helping these efforts.
- MQIC reviews the guidelines every two years or as needed. MQIC also works closely with the Michigan Interplan Behavioral Workgroup to incorporate behavioral guidelines.
- We have also adopted the Institute for Clinical Systems Improvement Stable Coronary Artery Disease guideline.
To learn more, see the resources below:
HAP Midwest 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.
These lists identify which services need prior authorization:
MI Health Link
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.
If you need to refer a member to an out-of-network provider, please contact our Customer Service team at (888) 654-2200. Select option two, then one.
To learn more about the step in the prior authorization process, see the Referrals and Authorizations section in the Provider Manual.
Newsletters and key information
Below you will find important news and updates from HAP Midwest.
07/08/19 07/08/19 05/31/19
12/31/18 12/21/18 12/17/18 09/18/18 09/18/18 08/24/18 07/25/18 06/19/18 06/7/18 03/9/18