HMA: Priority Health's TPA product

You won't be able to use prism's Member Inquiry to confirm eligibility or check benefits information for HMA plan members. Instead, you should call HMA's support line at 833.865.0141. If you have the HMA provider portal, you'll be able to check there for eligibility and benefits information too.

Need a prior authorization? You can call HMA's support line at 833.865.0141. The support line can also help you determine if a particular service code needs a prior authorization.

Prior authorization turnaround time for HMA members is a maximum of 15 days. HMA will send you a letter with the decision. If the authorization is denied, you'll also receive a phone call.

If you have the HMA provider portal, you'll be able to submit authorization requests there too.

Claims should be submitted to HMA, not Priority Health. HMA accepts electronic claims through Availity using payer ID HMA01. You can also submit claims via fax at 866.458.5488 or via mail to:

HMA
Attn: Claims Department
P.O. Box 85008
Bellevue, WA 98015

Please follow ICD-10 coding guidelines. 

To check the status of claims, call the HMA support line at 833.865.0141 or on Availity, if you submitted the claim there. If you have the HMA provider portal, you can track claims there too.

If your claim is accepted, you'll receive a paper check for payment until you complete an enrollment form for Electronic Funds Transfer (EFT) with ECHO, HMA’s payment partner.

Providers may appeal authorization and claim denials on behalf of a member. To do so, write to HMA, including the following information:

• A detailed description of the disputed issue(s)
• The basis for disagreement with the decision
• All evidence and clinical documentation supporting your position

HMA also needs a completed Appeal Submission Form signed by the member in order for the provider to appeal on behalf of the member. Without this completed and signed form, appeals will be rejected and an Appeal Submission Form will be mailed out.

You may also download and print the Appeal Submission Form and send it in via fax to 855.462.8875 or via mail to:

HMA
Attn: Appeals Department
P.O. Box 85016
Bellevue, WA 98015

Note that this appeals information is always included on claim and authorization denial documentation.

 

Call HMA's support line at 833.865.0141. Live representatives are available Monday–Friday, 8:00AM–9:00PM Eastern Time. Make sure when you call in that you have your NPI and your Tax ID number, as well as the member’s ID number and birth date. You should also have your fax number ready if you want the information you’re seeking faxed to you afterward.

If you have the HMA provider portal, you'll be able to submit inquiries (Express Requests) there. Response time is a maximum of 15 days. The exact amount of time depends on the complexity of the question. Over half of Express Requests are answered same-day.

A third-party administrator (TPA) is a company that provides operational services, such as prior authorizations, claims processing, member support, etc. This TPA product will be administered by HMA, while the member maintains access to the Priority Health network. It is not a leased network. 

Healthcare Management Administrators, Inc. (HMA) is our strategic collaborator for this product, and they're the organization that members and providers will be working throughout a member's care journey. HMA is a leading third-party administrator (TPA) of benefits for self-funded health plans, expertly serving employers for nearly 40 years. Learn more about HMA on their website.

We anticipate that this will be a niche product with slow growth in the market. We’re anticipating only a few thousand members the first year, primarily in the West and Southeast regions of Michigan.

Yes. This product will use our broad network PPO rates within our existing provider agreements, so your reimbursement shouldn’t be impacted.*

*Note that HMA has its own payment integrity processes.

No. If you’re a credentialed provider with Priority Health's PPO network, you’re all set to serve HMA plan members.

HMA uses Cigna’s medical policies as primary. If Cigna lacks relevant policy, HMA will turn to MCG criteria. MCG provides evidence-based guidelines for medical necessity. When Cigna does not offer a suitable policy for cancer cases, HMA will rely on the National Comprehensive Cancer Network (NCCN).

When necessary, HMA will engage AllMed Healthcare Management for independent physician review.