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  • Direct Member Reimbursement Form From Hap

Get Direct Member Reimbursement Form From Hap

DIRECT PAYMENT CONSIDERATION FORM For members of HAP Senior Plus (hmo), HAP Senior Plus (hmo-pos), and Alliance Medicare PPO Please use this form each time you are submitting claims to us for review.

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HAP HMO Medicare Advantage plans include a visitor/travel benefit in Florida, Arizona, Texas and out-of-area Michigan*. This is a great option if you travel to warmer climates during the winter.

HAP has received 4.5 stars out of 5 stars for our Medicare Advantage HMO plans and 4 stars out of 5 stars for our PPO plans from the Center for Medicare and Medicaid Services.

Submitting claims with dates of service July 1, 2019, forward • Use Change Healthcare clearinghouse • HAP Payer ID: 38224 • Submit via paper to: HAP Empowered Claims P.O. Box 2578 Detroit, MI 48202 • Note: You can no longer enter 5010 professional claims online.

HAP has partnered with Aetna Signature Administrators® to offer the Aetna national PPO network outside of Michigan and Northwest Ohio*. Aetna's network gives you access to more than 1.4 million providers including over 6,100 hospitals and thousands of MinuteClinic® locations around the country.

Please complete the following: Provider Enrollment Form. HAP Disclosure of Ownership and Control Interest form. Collaborative Physician Agreement (nurse practitioner/physician assistant only) Childrens Special Healthcare Services Provider Attestation_fillable (if applicable)

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232