Oakland Southfield Physicians

OSP News

Reducing Administrative Burden for Your Office - Prior Authorization Changes for HAP Medicare Plans

Posted: 03/12/2020

Effective immediately, prior authorization for most part B medical drugs will not be required for HAP Primary Choice Medicare (HMO) and HAP Choice Medicare (HMO) plans. Since 2019, other HAP Medicare plans have not required authorization for these drugs. Now all HAP Medicare plans will be better aligned. Note: prior authorization is still required for Botox (J0585) and Xiaflex (J0775).

Claims
HAP will review claims with dates of service January 1, 2020 to present. Appropriate action will be taken for claims with incorrect denials related to prior authorizations for these drugs.

Prior Authorization Requirements
The most up-to-date rules and a comprehensive list of services requiring prior authorization can always be found in the Procedure Reference List. To view the list:

  • Log in at hap.org
  • Select Procedure References Lists under Quick Links
  • Select Services that require Prior Authorization List
  • Search for a code

 

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