HAP's Benefit Coverage Policies are written on selected clinical issues, especially addressing new technologies, new treatment approaches used with existing technology, and procedures. HAP's Benefit Coverage Policies are used as a tool to be interpreted in conjunction with the Member's specific benefit plan and after consultation with the treating physician. HAP's Benefit Coverage Policies can be highly technical and are designed to be used as a guide by our professional clinical staff in making coverage determinations.
HAP's Benefit Coverage Policies apply to all HAP lines of business offered through any HAP affiliate including insured and self-funded plans except for the following: These Benefit Coverage Policies do not apply to lines of business offered through HAP affiliates ASR and Midwest Health Plan.
Please be advised that some services must be performed in certain clinical settings and/or by specific provider specialties. Providers must follow HAP's referral and practice guidelines as well as the Utilization Management Lists when providing services to our Members to ensure appropriate reimbursement.
The information contained in this manual is protected by copyright laws and is not intended to be reprinted or distributed to individuals not directly related to doing business of HAP. Duplication should occur only with permission from the HAP Corporate Office.
Current Procedural Terminology (CPT) is copyright 2018 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.
Copyright © 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017, 2018 by Health Alliance Plan. This document is protected by copyright laws and may not be duplicated, distributed or reprinted. This document is for the exclusive use of HAP employees, providers and members while doing the business of HAP.