HAP Midwest Health Plan’s Claims And Electronic Data Interchange Program
HAP Midwest Health Plan’s Claims Department endeavors to assure prompt and accurate claim and encounter review, processing, adjudication and payment. This is accomplished through the development of claims processing systems, pre-payment and post-payment audits, policies, and procedures that are consistently and appropriately applied.
HAP Midwest Health Plan’s Claims Definitions and Encounters
HAP Midwest Health Plan defines a “claim” as a properly completed claim form (CMS1500, UB04 or electronic version), submitted by a valid provider, for service(s) rendered to an eligible member. Services for-fee-for service and capitation may be billed together on the same form. Partners should refer to their contract with HAP Midwest Health Plan’s Claims department for list of capitated procedure codes, if applicable. Capitated procedure codes are reviewed and updated annually.
HAP Midwest Health Plan’s Claims EDI Submission
HAP Midwest Health Plan accepts claims submitted in the following formats:EDI Claims Information regarding electronic claims submission:
- First time submitters please check with your clearing house for the correct payor ID to use when sending claims to HAP Midwest Health Plan. Also please use the link on the providers home page “Verify Vendor” to make sure the provider payment address is exactly the way you are submitting on your 837.
Paper Claims – Claim Formats and Versions
Professional Services, use the CMS-1500(02-12) form. For facility services use the UB-04 form. Handwriting is not acceptable anywhere on the claim form except for the signature items.
Clean Claim Submission Requirements
In general, HAP Midwest Health Plan follows Michigan Medicaid Uniform Billing Guidelines. Indicate the appropriate HAP Midwest Health Plan product name on the claim (upper right corner on a CMS 1500 form and FL61 on a UB-04 form) and on the outside of the mailing envelope. E.g. Midwest Health Plan and Midwest Advantage etc.