Health Alliance Plan (HAP) Prior Authorization Lookup
- Health Alliance Plan (HAP) coverage criteria
- Health Alliance Plan (HAP) contact directory
- All Health Alliance Plan (HAP) policy updates
Latest Health Alliance Plan (HAP) prior authorization updates16
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Alpha-1 Antitrypsin (AAT) deficiency therapies prior authorizationDefines prior authorization requirements for AAT augmentation products (ARALAST NP, GLASSIA, PROLASTIN-C, ZEMAIRA) including required clinical information, prescriber restrictions, and coverage duration for Health Alliance Plan members.All Health Alliance Plan (HAP) updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Prior Authorization Criteria — A1-PI Augmentation Products and Selected Specialty AgentsPrior authorization and coverage guidance for A1-PI augmentation products (ARALAST NP, GLASSIA, PROLASTIN-C, ZEMAIRA) including required documentation, prescriber restrictions, and coverage duration for Health Alliance Plan members.All Health Alliance Plan (HAP) updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-06-01DME Services that require Prior Authorization ListA list and guidance specifying durable medical equipment (DME) supplies and services that require prior authorization from Health Alliance Plan (HAP), and instructions for providers and vendors on verifying member benefits and authorization requirements.All Health Alliance Plan (HAP) updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-04-01DME Services that require Prior Authorization ListGovernance of prior authorization requirements for durable medical equipment (DME) services and supplies for HAP members; applies to providers, vendors, and referral/TPA arrangements as described.All Health Alliance Plan (HAP) updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01HAP Medicare Part B Prior Authorization and Step Therapy CriteriaDefines prior authorization and step therapy requirements, documentation expectations, and coverage determination approach for outpatient drugs and biologics billed under HAP Medicare Part B for providers submitting Part B drug requests.All Health Alliance Plan (HAP) updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Medicare Part B Prior Authorization and Step Therapy CriteriaDefines HAP Medicare Part B prior authorization and step therapy requirements, clinical review approach, and documentation expectations for outpatient drugs/biologics administered under Medicare Part B. Affects providers requesting coverage for Part B drugs for HAP Medicare members.All Health Alliance Plan (HAP) updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Qualified Health Plan Prescription Drug Formulary / Coverage CriteriaDefines the prescription drugs covered for Qualified Health Plans (QHPs), how the formulary is organized, tiers, and coverage controls (prior authorization, quantity limits, step therapy, specialty pharmacy). Affects members and prescribing providers using HAP QHPs.All Health Alliance Plan (HAP) updates
- Prior AuthClinical/Medical PolicyEff. 2025-10-01Qualified Health Plan (QHP) Prescription Drug Formulary Coverage CriteriaGoverns the prescription drugs covered for HAP Qualified Health Plans (ACA-compliant), including formulary tiers, prior authorization, quantity limits, step therapy, specialty pharmacy requirements, and exclusions; affects members and prescribing providers for HAP QHP products.All Health Alliance Plan (HAP) updates
- Prior AuthClinical/Medical PolicyEff. 2024-04-01Procedure Reference Lists (prior authorization and coverage lookup)Guidance for searching HAP Procedure Reference Lists to determine coverage, prior authorization, and billing requirements for procedure and drug codes; intended for providers and staff who submit authorizations or bill HAP.All Health Alliance Plan (HAP) updates
- Prior AuthAdministrative/Operational PolicyEff. 2023-06-01Prior Authorization Reform - What You Need to Know from Senate Bill 247This document outlines HAP's operational standards and procedures to comply with Michigan Senate Bill 247 prior authorization reforms, including submission channels, notification timelines, and decision timeframes for contracted and non-contracted providers.All Health Alliance Plan (HAP) updates
- Prior AuthClinical/Medical PolicyEff. 2008-01-01CBHM Outpatient Authorization Requirement List (Outpatient behavioral health authorization requirements)Defines which outpatient mental health and substance abuse procedure codes require prior authorization, are not covered, or do not require authorization for HAP members; applies to contracted behavioral providers and billing for outpatient services.All Health Alliance Plan (HAP) updates
- Prior AuthAdministrative/Operational PolicyEff. 2008-01-01DME Services that require Prior Authorization ListA provider-facing list of durable medical equipment (DME) HCPCS codes and authorization requirements used to determine when prior authorization is required for Health Alliance Plan (HAP) members; applies to providers and contracted vendors and varies by product line.All Health Alliance Plan (HAP) updates
- Prior AuthClinical/Medical PolicyCommercial Prescription Drug Formulary and Utilization Management (Pharmacy & Specialty Drugs)Governs the prescription drugs covered for Health Alliance Plan (HAP) commercial health plans, including tiers, utilization management (PA, QL, ST), specialty pharmacy requirements, and how to request exceptions or prior authorization. Affects members, prescribers, pharmacies, and specialty pharmacy vendors for HAP commercial plans.All Health Alliance Plan (HAP) updates
- Prior AuthAdministrative/Operational PolicyMichigan standard prior authorization form for prescription drugs (FIS 2288)Governs use of the Michigan Department of Insurance and Financial Services standard prior authorization form (FIS 2288) for prescription drug prior authorization requests submitted by prescribers to health plans in Michigan.All Health Alliance Plan (HAP) updates
- Prior AuthClinical/Medical PolicyServices and procedures requiring prior authorizationThis document lists services and procedures that require prior authorization from Health Alliance Plan (HAP) and guides providers and members about where to request authorizations. It applies to HAP members and contracted and non-contracted providers subject to the member's benefit documents.All Health Alliance Plan (HAP) updates
- Prior AuthClinical/Medical PolicyServices and procedures requiring prior authorizationThis document lists services, procedures, providers, and settings that require prior authorization from Health Alliance Plan (HAP) and provides guidance on where providers should submit authorization requests. It applies to HAP members, providers, and facilities submitting requests for covered services.All Health Alliance Plan (HAP) updates
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Tool Description
Search Health Alliance Plan (HAP)prior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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