Help Guide
HAP Midwest Health Plan has created different types of users to enable the appropriate access to
information that may be accessed on our website.
Access Levels are as follows:
Member
HAP Midwest Health Plan Enrollee
Required to Gain Access:

Member ID (found on ID card)

Date of Birth

First and Last name (as it appears on ID card)
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator
This is the owner/Administrator of the Federal Tax Identification Number. This user will be responsible for
maintaining Provider Users and Biller Administrators access to confidential information associated with
the Federal Tax Identification Number.
Required to gain access:

Federal Tax Identification Number

Check Date and Number from the last six months
Provider User
Employee/Contractor of the Provider Administrator.
Required to gain access:

Providers Federal Tax Identification Number you are trying to gain access.
Billing Agency Administrator
Billing Agency/Owner of Federal Tax Identification Number associated with the organization that will be
accessing Provider’s confidential data. This user will be responsible for maintaining Biller Users access to
confidential information.
Required to gain access:

Federal Tax Identification Number
Billing Agency Representative
Employee/Contractor of the Biller Administrator.
Required to gain access:

Biller Administrator’s Federal Tax Identification Number
Trading Partner/Submitter
This is an entity that does files transfers with HAP Midwest Health Plan.
Required to gain access:

Federal Tax Identification Number
Employee
HAP Midwest Health Plan Employees
Required to gain access:

HAP Midwest Health Plan system username
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Contents
Help Guide ....................................................................................................................................................................1
Provider Administrator Help Guide ............................................................................................................................ 6
Provider Administrator Registration ......................................................................................................................6
Provider Administrator Login ............................................................................................................................. 7
Provider Administrator Manage User Access .......................................................................................................8
Provider Administrator Add Provider Tax ID....................................................................................................... 10
Provider Administrator Validate Provider Tax ID PIN ......................................................................................... 11
Provider Administrator View Authorizations and Referrals ............................................................................... 12
Provider Administrator Enter Auth/Referral ........................................................................................................ 13
Entering a New Authorization using Clear Coverage ..................................................................................... 14
Provider Administrator Claims ............................................................................................................................. 22
Provider Administrator Eligiblity .......................................................................................................................... 24
Provider Administrator Financial Statements ..................................................................................................... 25
Provider Admninistrator Provider Contracts ...................................................................................................... 26
Provider Administrator Remittance Advice ......................................................................................................... 27
Provider Administrator Care Coordination.......................................................................................................... 28
Provider Administrator EDI 837 Claim Errors ..................................................................................................... 29
Provider Administrator EDI 5010 .......................................................................................................................... 30
Provider Administrator EDI 835 ............................................................................................................................ 31
Provider Administrator Pick Up 997 ..................................................................................................................... 32
Provider Admnistrator Pick Up 277CA ................................................................................................................ 33
Provider Administrator ICD-10 Testing ................................................................................................................ 34
Provider Administrator Editing profile ................................................................................................................. 35
Provider Users Help Guide ........................................................................................................................................ 36
Provider User Registration ................................................................................................................................... 36
Provider User Login .......................................................................................................................................... 38
Provider User Request Access............................................................................................................................. 39
Provider User Email Admin................................................................................................................................... 40
Provider User Authorization and Referral ........................................................................................................... 41
Provider User Enter Auth/Referral ....................................................................................................................... 42
Entering a New Authorization using Clear Coverage ..................................................................................... 43
Provider User Claims ............................................................................................................................................ 51
Provider User Eligibility ........................................................................................................................................ 53
Provider User Financial Statement ...................................................................................................................... 54
Provider User Contracts ....................................................................................................................................... 55
Provider User Remittance Advice ........................................................................................................................ 56
Provider User Care Coordination ......................................................................................................................... 57
Provider User EDI 837 Claim Errors ..................................................................................................................... 58
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User EDI 5010 ......................................................................................................................................... 59
Provider User EDI 835 ........................................................................................................................................... 60
Provider User Pick Up 997 .................................................................................................................................... 61
Provider User Pick Up 277CA ............................................................................................................................... 62
Provider User ICD10-Testing ................................................................................................................................ 63
Provider User Editing Profile ................................................................................................................................ 64
Member Help Guide ................................................................................................................................................... 65
Member Registration ............................................................................................................................................. 65
Member Log In ................................................................................................................................................... 65
Member Dashboard ............................................................................................................................................... 66
My Message............................................................................................................................................................ 66
Order ID Card ......................................................................................................................................................... 68
Change PCP ........................................................................................................................................................... 69
View Claims ............................................................................................................................................................ 70
View Authorizations .............................................................................................................................................. 71
Enroll in Disease Management Program ............................................................................................................. 72
Care Coordination ................................................................................................................................................. 73
Member Portal Health & Wellness ........................................................................................................................ 74
Member Portal Editing profile ............................................................................................................................... 75
Billing Agency Administrator Help Guide ................................................................................................................ 76
Billing Agency Administrator Registration.......................................................................................................... 76
Billing Agency Administrator Log In ............................................................................................................... 77
Billing Agency Administrator Select Provider ................................................................................................ 77
Billing Agency Administrator Manage user access ............................................................................................ 77
Billing Agency Administrator Edit user access .............................................................................................. 78
Billing Agency Administrator Request a Provider .............................................................................................. 79
Billing Agency Administrator Remind Provider .................................................................................................. 80
Billing Agency Administrator View Provider Access ......................................................................................... 81
Billing Agency Administrator Request Permission ............................................................................................ 82
Billing Agency Administrator Email Admin ......................................................................................................... 83
Billing Agency Administrator Switching/Changing Provider ............................................................................. 84
Billing Agency Administrator Authorization and Referrals................................................................................ 85
Billing Agency Administrator Enter Auth/Referral .............................................................................................. 86
Entering a New Authorization using Clear Coverage ..................................................................................... 87
Billing Agency Administrator Claims ................................................................................................................... 95
Billing Agency Administrator Eligibility............................................................................................................... 97
Billing Agency Administrator Financial Statement ............................................................................................. 98
Billing Agency Administrator Provider Contracts .............................................................................................. 99
Billing Agency Administrator Remittance Advice ............................................................................................ 100
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator EDI 837 Claim Errors ......................................................................................... 101
Billing Agency Administrator EDI 5010 ............................................................................................................. 102
Billing Agency Administrator EDI 835 ............................................................................................................... 103
Billing Agency Administrator Pick Up 997 ........................................................................................................ 104
Billing Agency Administrator Pick Up 277CA ................................................................................................... 105
Billing Agency Administrator ICD10-Testing .................................................................................................... 106
Billing Agency Administrator Edit Profile.......................................................................................................... 107
Billing Agency Representative Help Guide ............................................................................................................ 108
Billing Agency Representative Registration ..................................................................................................... 108
Billing Agency Representative Log in ........................................................................................................... 109
Billing Agency Representative Select a Provider ......................................................................................... 109
Billing Agency Representative View Provider Access ..................................................................................... 110
Billing Agency Representative Request Access............................................................................................... 111
Billing Agency Representative Email Admin..................................................................................................... 112
Billing Agency Representative Switching/Changing Provider ........................................................................ 113
Billing Agency Representative Authorizations and Referrals ......................................................................... 114
Biller Agency Represntative Enter Auth/Referral ............................................................................................. 115
Entering a New Authorization using Clear Coverage ................................................................................... 116
Biller Agency Representative Claims ................................................................................................................ 124
Billing Agency Representative Eligibility .......................................................................................................... 126
Billing Agency Representative Financial Statement ........................................................................................ 127
Provider Agency Representative Provider Contracts ...................................................................................... 128
Billing Agency Representative Remittance Advice .......................................................................................... 129
Billing Agency Representative EDI 837 Claim Errors ....................................................................................... 130
Billing Agency Representative EDI 835 ............................................................................................................. 132
Billing Agency Representative Pick Up 997 ...................................................................................................... 133
Billing Agency Representative Pick Up 277CA ................................................................................................. 134
Billing Agency Representative ICD10-Testing .................................................................................................. 135
Billing Agency Representative Edit Profile ....................................................................................................... 136
Trading Partner/Submitter Help Guide ................................................................................................................... 137
Trading Partner/Submitter Registration............................................................................................................. 137
Trading Partner/Submitter Log in .................................................................................................................. 138
Trading Partner/Submitter Upload Documents ................................................................................................. 138
Trading Partner/Submitter Edit Profile .............................................................................................................. 140
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator Help Guide
Provider Administrator Registration
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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After successfully registering you will be emailed an activation link.
After activating the account the Provider Administrator will be need to login to view the Dashboard
Provider Administrator Login
When a Provider Administrator registers without a check number they will be prompted to enter a PIN
number the first time they attempt to log into the Provider Profile.
The PIN will be mailed to the primary payment address in 3-5 business days.
The Provider Admin will be given the change to enter either the PIN or a check number the first time they
log into the Provider Portal.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator Manage User Access
From the Dashboard the Provider Administrator will be able to manage all Provider Users and Billing
Agency Administrators access to their confidential information.
Clicking on Edit links allows the Provider Administrator to modify Provider users and Billing
Administrator’s accessibility.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Click Update after making changes.
Permissions
Remittance Advice (RA)
Grants the ability to view all documents
supplied that provides notice of and
explanation reasons for payment,
adjustment, denial and/or uncovered
charges of a claim.
835
Grants access to view electronic
Remittance Advices.
Finance Reports (FR)
Grants access to the financial activities
of the Provider
Eligibility (ELIG)
Grants access to view members
eligibility.
View Claim (VC)
Grants access to view Providers claims
Enter Claims (EC)
Grants access to enter claims on behalf
of the Provider
Auth
Grants access to view authorizations
Upload Documents (UF)
Grants access to upload documents on
behalf of the Provider. (Only Provider
users will be allowed to upload
documents)
Status
The Admin can change the status of
any user who has access to their
information. (Active, Inactive, Pending)
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator Add Provider Tax ID
If the Provide Administrator wishes to become the Provider Administrator for more than one Provider they
can register the new TAX ID by clicking add Provider Tax ID.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator Validate Provider Tax ID PIN
From the dashboard the Provider Administrator will be able to validate the Provider Tax ID number that
they registered
Select the Provider from the drop down and click Submit
Enter the PIN or the Check number and Check Date and click Submit
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator View Authorizations and Referrals
From the Dashboard the Provider Administrator will be able to view Authorizations and Referrals
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator Enter Auth/Referral
From the dashbaord click on Enter Auth/Referral and Clear Coverage will lauch.
Clear Coverage is a web based application, offers the ability to submit an Authorization Request/Prior
Authorization (PA) for procedures and receive an immediate, real‐time response to that request.
Once Clear Coverage launches the application will launch/load to the Clear Coverage home page.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Entering a New Authorization using Clear Coverage
From the Clear Coverage home screen select New Authorization
In the Patient Search Accordion, search for a member by entering the subscriber ID number located on
the members HAP Midwest Health Plan card.
In the Search Results window, press the SELECT button next to the patient you are searching for
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Verify patient’s information and select the ADD TO REQUEST button
Next step is to enter the Requesting Information (Referred by Provider)
Date of Service – Date the service/rental will be performed
Users may back-date up to 3 days and future-date up to 30 days
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Select a Referred by Provider choosing the Select Other Clinician link
Type the requester name and hit serach after slecting the provider click use slelectd to add the Provider
to the authorization.
Use Selected
After verifying the Referred by Providers address and Verifying the Date of Service, select the ADD TO
REQUEST button.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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In the Diagnosis Accordion, search for billable Diagnois
A Diagnosis description or ICD9/10 can be entered
Select the ADD button, and press NEXT
In the Service Accordion, search for the Service/Test,
A service/test description or CPT/HCPCS code can be entered.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Select the Service/Test click the ADD button, and press NEXT.
In the Service Information accordion complete the required information, then press NEXT.
A. Priority – This field defaults to Normal, but can be changed
B. Primary Diagnosis –Select the primary diagnosis from the drop down
C. Servicing Facility – Choose the appropriate servicing Facility or Provider if referring to a Physician’s
office
D. Details – Additional information is required, a symbol will appear indicating that certain details are
required such as: Place of Service, Referred to Provider, Units/Frequency/Duration
Enter the Referred to Providers information
(Specialist, PT, OT, DME etc.)
Input “N/A” in “Referral Number” field
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Search for the Referred to Provider (Specialist, DME, OT, PT, etc.) by name
Select the Provider
In-Plan
Facility and patient have matching HAP Midwest Health Plan products (ex. HMP, AKM)
In-Network
Facility and patient do not have matching HAP Midwest Health Plan products
Click Next
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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In the Additional Notes accordion, add any notes or supporting documentation
Verify the Authorization Request details are correct in the right panel
Select the button in the lower right panel (hover over this button if not active)
A request confirmation will be created for each service/test
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Print a Report containing information on the request by selecting the View Request PDF link, then select
to create another Auth for the same patient or
authorization for a new patient.
to go back to the main screen to create an
Users must enter a contact phone number before the authorization request can be submitted
The user’s contact phone number is added to the authorization request as a note
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator Claims
From the Dashboard the Provider Administrator will be able to view and submit claims by clicking on the
Claims link
To seach Claims click on Search Claims
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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To Enter Claims click Enter Professional 5010 Claims
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator Eligiblity
From the Dashboard the Provider Administrator will be able to view the Eligiblity of their patients by
clicking on Eligiblity List.
Once the Provider Administrator is on the eligibility list page the Provider Administrator will select the site
they wish to view eligibility.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator Financial Statements
From the Dashboard the Provider Administrator will be able to view their Financial Statements by clicking
on Vendor Financial Statements.
Click LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Admninistrator Provider Contracts
From the Dashboard the Provider Administrator will be able to download standard Provider agreement
by clicking on Provider Contracts.
Click LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator Remittance Advice
From the Dashboard the Provider Administrator will be able to download Remittance Advice Statements
by clicking on Remittance Advice.
Click LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator Care Coordination
Coordinated care uses broad approaches to improve health care delivery and using specific
care coordination activities
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator EDI 837 Claim Errors
From the Dashboard the Provider Administrator will be able to download EDI Claim Errors by clicking on
EDI 837 Claim Errors.
Click LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator EDI 5010
From the Dashboard the Provider Administrator will be able to submit EDI 5010 claims and other
documents by clicking on EDI 5010
Select the type from the drop down list
Uploaded your document by click the select button. Please pay attention to the
Naming Convention, and Allowed File Extension types.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator EDI 835
From the Dashboard the Provider Administrator will be able to download EDI 835s by clicking EDI 835
Click LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator Pick Up 997
From the dashboard the Provider will be able to see if their EDI transaction has been acknowledge.
Please note this is not the acknowledgement of the claim but the acknowledgment of the transmittal of the
claim.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Admnistrator Pick Up 277CA
The purpose for the 277CA Claims Acknowledgement report (277CA) is to provide a claim-level
acknowledgement of all claims received in the front-end processing system before claims are sent into
the adjudication system.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator ICD-10 Testing
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Administrator Editing profile
Click on My Profile (Top right corner it’s hidden near your username)
Note: You will be able to view your permissions by clicking My Profile.
Click Edit to reset Password, Change Email address and Edit Security Information.
If you need to update your address and/or phone number Contact your Provider Representative.
Note: You will be able to view your permissions by clicking My Profile.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider Users Help Guide
Provider User Registration
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Select the permissions you will need from the Provider
Permissions
Remittance Advice
Grants the ability to view all
documents supplied that provides
notice of and explanation reasons for
payment, adjustment, denial and/or
uncovered charges of a claim.
835
Grants access to view electronic
Remittance Advices.
Finance Reports
Grants access to the financial
activities of a business, person, or
other entity
Eligibility
Grants access to view members
eligibility.
Claims and Auths
Grants access to view and/or enter
claims and authorizations for the
Provider.
After successfully registering you will be emailed an activation link.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User Login
The Provider User Dashboard will appear.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User Request Access
From the Dashboard the Provider User will be able to request their access be modified/updated by
clicking on Request Access
Permissions
Remittance Advice (RA)
Grants the ability to view all documents
supplied that provides notice of and
explanation reasons for payment,
adjustment, denial and/or uncovered
charges of a claim.
835
Grants access to view electronic
Remittance Advices.
Finance Reports (FR)
Grants access to the financial activities
of the Provider
Eligibility (ELIG)
Grants access to view members
eligibility.
View Claim (VC)
Grants access to view Providers claims
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Enter Claims (EC)
Grants access to enter claims on behalf
of the Provider
Auth
Grants access to view authorizations
Upload Documents (UF)
Grants access to upload documents on
behalf of the Provider. (Only Provider
users will be allowed to upload
documents)
Status
The Admin can change the status of
any user who has access to their
information. (Active, Inactive, Pending)
Provider User Email Admin
From the Dashboard the Provider User will be able to email the Provider Administrator any questions,
issues, or concerns by clicking Email Admin
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User Authorization and Referral
From the Dashboard the Provider User will be able to view Authorizations and Referrals by clicking on
View Auths/Referrals
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User Enter Auth/Referral
From the dashbaord click on Enter Auth/Referral and Clear Coverage will lauch.
Clear Coverage is a web based application, offers the ability to submit an Authorization Request/Prior
Authorization (PA) for procedures and receive an immediate, real‐time response to that request.
Once Clear Coverage launches the application will launch/load to the Clear Coverage home page.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Entering a New Authorization using Clear Coverage
From the Clear Coverage home screen select New Authorization
In the Patient Search Accordion, search for a member by entering the subscriber ID number located on
the members HAP Midwest Health Plan card.
In the Search Results window, press the SELECT button next to the patient you are searching for
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Verify patient’s information and select the ADD TO REQUEST button
Next step is to enter the Requesting Information (Referred by Provider)
Date of Service – Date the service/rental will be performed
Users may back-date up to 3 days and future-date up to 30 days
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Select a Referred by Provider choosing the Select Other Clinician link
Type the requester name and hit serach after slecting the provider click use slelectd to add the Provider
to the authorization.
Use Selected
After verifying the Referred by Providers address and Verifying the Date of Service, select the ADD TO
REQUEST button.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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In the Diagnosis Accordion, search for billable Diagnois
A Diagnosis description or ICD9/10 can be entered
Select the ADD button, and press NEXT
In the Service Accordion, search for the Service/Test,
A service/test description or CPT/HCPCS code can be entered.
Select the Service/Test click the ADD button, and press NEXT.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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In the Service Information accordion complete the required information, then press NEXT.
A. Priority – This field defaults to Normal, but can be changed
B. Primary Diagnosis –Select the primary diagnosis from the drop down
C. Servicing Facility – Choose the appropriate servicing Facility or Provider if referring to a Physician’s
office
D. Details – Additional information is required, a symbol will appear indicating that certain details are
required such as: Place of Service, Referred to Provider, Units/Frequency/Duration
Enter the Referred to Providers information
(Specialist, PT, OT, DME etc.)
Input “N/A” in “Referral Number” field
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Search for the Referred to Provider (Specialist, DME, OT, PT, etc.) by name
Select the Provider
In-Plan
Facility and patient have matching HAP Midwest Health Plan products (ex. HMP, AKM)
In-Network
Facility and patient do not have matching HAP Midwest Health Plan products
Click Next
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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In the Additional Notes accordion, add any notes or supporting documentation
Verify the Authorization Request details are correct in the right panel
Select the button in the lower right panel (hover over this button if not active)
A request confirmation will be created for each service/test
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Print a Report containing information on the request by selecting the View Request PDF link, then select
to create another Auth for the same patient or
authorization for a new patient.
to go back to the main screen to create an
Users must enter a contact phone number before the authorization request can be submitted
The user’s contact phone number is added to the authorization request as a note
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User Claims
From the Dashboard the Provider User will be able to view and submit claims by clicking on the Claims
link
To seach Claims click on Search Claims
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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To Enter Claims click Enter Professional 5010 Claims
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User Eligibility
From the Dashboard the Provider User will be able to view the Eligiblity of their patients by clicking on
Eligiblity List.
Once the Provider User is on the eligibility list page the Provider User will select the site they wish to view
eligibility.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User Financial Statement
From the Dashboard the Provider User will be able to view their Financial Statements by clicking on
Vendor Financial Statements.
Click LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User Contracts
From the Dashboard the Provider User will be able to download standard provider agreements by clicking
on Provider Contracts.
Click LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User Remittance Advice
From the Dashboard the Provider User will be able to view their Remittance Advice Statements by
clicking on Remittance Advice.
Click LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User Care Coordination
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User EDI 837 Claim Errors
From the Dashboard the Provider User will be able to view their EDI Claim Errors by clicking on EDI 837
Claim Errors.
Click LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User EDI 5010
From the Dashboard the Provider will be able to submit EDI 5010 claims and other documents by clicking
on EDI 5010
Select the type from the drop down list
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Uploaded your document by click the select button. Please pay attention to the Naming Convention, and
Allowed File Extension types.
Provider User EDI 835
From the Dashboard the Provider will be able to download EDI 835s by clicking EDI 835
Click on LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User Pick Up 997
From the dashboard the Provider will be able to see if their EDI transaction has been acknowledge.
Please note this is not the acknowledgement of the claim but the acknowledgment of the transmittal of the
claim.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User Pick Up 277CA
The purpose for the 277CA Claims Acknowledgement report (277CA) is to provide a claim-level
acknowledgement of all claims received in the front-end processing system before claims are sent into
the adjudication system.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User ICD10-Testing
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Provider User Editing Profile
Editing profile
Click on My Profle (Top right corner its hidden near your username)
Click Edit to reset Password, Change Email address and Edit Security Information. If you need to update
your address and/or phone number Contact your Provider Representative.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Member Help Guide
Member Registration
After successfully registering you will be emailed an activation link.
Member Log In
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Member Dashboard
Once logged into member account the member will view the Member Dashboard
The member will be able to send messages, Order ID cards, Change PCP, View Claims and sign up
for Disease Management programs, etc.
My Message
The dashboard will allow the user to communicate with customer service without picking up the phone.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Clicking on My messages allows the member to send and receive messages to communicate with
Customer Service.
Click on New message and select message type

Billing Issues

Eligibility Questions

General Questions

PCP Change

Transportation Request
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Once your message has been composed click Send
Order ID Card
Click on Order ID Card to order a New or Replacement ID Card.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Your New/Replacement ID card will arrive in 7-10 business days.
Change PCP
Click on Change PCP to select a New PCP
Members can search for providers by Name, Zip code, and/or Specialty
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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View Claims
Click on View Claims to view claims history, click on DOS (date of service to sort by date)
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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View Authorizations
From the Dashboard the Member will be able to view all Authorizations/Referrals that have been
submitted/Requested and Approved
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Enroll in Disease Management Program
Click on Disease Management to enroll in a variety of programs that will help you stay healthy
and happy
The Disease Management programs available are:






Diabetes Disease Management Program
Asthma Disease Management Program
Hypertension Disease Management Program
ROSEBUD® Pregnancy Program
Maternal Infant Health Program (MIHP)
Smoking Cessation Program
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Care Coordination
From the dashboard the member will be able to view communication regarding his or her Case
Manager to help coordinate their care.
Coordinated care uses broad approaches to improve health care delivery and using specific care
coordination activities.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Member Portal Health & Wellness
The member Health and Wellness portal provides:





Online Health Risk Assessment
Personal Health Record
Health Library
Health Trackers
o Exercise, Nutrition
o Blood pressure
o Cholesterol, Hemoglobin A1C, Peak flow
o Pain rating, Stress
o Tobacco use
o BMI
Self-Management Programs
o Preventive Care
o Back Pain
o Exercise
o Nutrition
o Pregnancy
o Stress Management
o Tobacco Cessation
o Weight Management
o Asthma
o Coronary Artery Disease
o Diabetes
o Hypertension
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Member Portal Editing profile
Click on My Profle (Top right corner its hidden near your username)
Click Edit to reset Password, Change Email address and Edit Security Information. If you need to
update your address and/or phone number Contact Customer Service 888-624-2400
Click Edit to reset Password, Change Email address and Edit Security Information. If you need to
update your address and/or phone number Contact Customer Service (888) 654-2200.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Help Guide
Billing Agency Administrator Registration
After successfully registering you will be emailed an activation link
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Log In
From the drop down list you will select the Provider you are trying to access.
Billing Agency Administrator Select Provider
Billing Agency Administrator Manage user access
From the dashboard the Billing Agency Administrator will be to manage all Provider Agency
Representative access to Providers confidential information.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Edit user access
Click Edit to modify, active, and/or deactivate a Provider Agency Representatives accessibility.
Permissions
Remittance Advice (RA)
835
Finance Reports (FR)
Eligibility (ELIG)
View Claim (VC)
Enter Claims (EC)
Auth
Upload Documents (UF)
Status
Grants the ability to view all documents
supplied that provides notice of and
explanation reasons for payment,
adjustment, denial and/or uncovered
charges of a claim.
Grants access to view electronic
Remittance Advices.
Grants access to the financial activities
of the Provider
Grants access to view members
eligibility.
Grants access to view Providers claims
Grants access to enter claims on behalf
of the Provider
Grants access to view authorizations
Grants access to upload documents on
behalf of the Provider. (Only Provider
users will be allowed to upload
documents)
The Admin can change the status of
any user who has access to their
information. (Active, Inactive, Pending)
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Request a Provider
To request access to a Providers confidential information click on the Request Provider link.
You will need to ender the Providers Federal Tax Identification Number, as well as select the
permissions you will require.
Permissions
Remittance Advice
835
Finance Reports
Eligibility
Claims and Auths
Grants the ability to view all
documents supplied that
provides notice of and
explanation reasons for
payment, adjustment, denial
and/or uncovered charges of a
claim.
Grants access to view electronic
Remittance Advices.
Grants access to the financial
activities of a business, person,
or other entity
Grants access to view members
eligibility.
Grants access to view and/or
enter claims and authorizations
for the Provider.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Remind Provider
Click on Remind Provider to send an email reminder to the Provider Administrator that you are still
waiting on your access to be approved.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator View Provider Access
From the Billing Agency Administrator dashboard the Billing Agency Representative will be able to view
the permissions and status they have for all Providers they have requested.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Request Permission
From the Billing Agency Administrator dashboard the Billing Agency Administrator will be able to request
a change in the level of access/permissions they have.
Select the Providers TIN form the drop down
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Select the permissions you need access too and click send request
Billing Agency Administrator Email Admin
From the dashboard the Billing Agency Administrator will be able to send communications to the Provider
Administrator by clicking on the Email Admin link.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Type your Message here and click send email.
Billing Agency Administrator Switching/Changing Provider
From the dashboard the Billing Agency Administrator that have access to multiple Providers can click on
Select Provider to switch between Providers without having to log out and back into the portal.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Authorization and Referrals
From the Dashboard the Billing Agency Administrator will be able to view Provider Authorizations and
Referrals by clicking on Auth/Referrals.
Enter searh criteira
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Enter Auth/Referral
From the dashbaord click on Enter Auth/Referral and Clear Coverage will lauch.
Clear Coverage is a web based application, offers the ability to submit an Authorization Request/Prior
Authorization (PA) for procedures and receive an immediate, real‐time response to that request.
Once Clear Coverage launches the application will launch/load to the Clear Coverage home page.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Entering a New Authorization using Clear Coverage
From the Clear Coverage home screen select New Authorization
In the Patient Search Accordion, search for a member by entering the subscriber ID number located on
the members HAP Midwest Health Plan card.
In the Search Results window, press the SELECT button next to the patient you are searching for
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Verify patient’s information and select the ADD TO REQUEST button
Next step is to enter the Requesting Information (Referred by Provider)
Date of Service – Date the service/rental will be performed
Users may back-date up to 3 days and future-date up to 30 days
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Select a Referred by Provider choosing the Select Other Clinician link
Type the requester name and hit serach after slecting the provider click use slelectd to add the Provider
to the authorization.
Use Selected
After verifying the Referred by Providers address and Verifying the Date of Service, select the ADD TO
REQUEST button.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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In the Diagnosis Accordion, search for billable Diagnois
A Diagnosis description or ICD9/10 can be entered
Select the ADD button, and press NEXT
In the Service Accordion, search for the Service/Test,
A service/test description or CPT/HCPCS code can be entered.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Select the Service/Test click the ADD button, and press NEXT.
In the Service Information accordion complete the required information, then press NEXT.
A. Priority – This field defaults to Normal, but can be changed
B. Primary Diagnosis –Select the primary diagnosis from the drop down
C. Servicing Facility – Choose the appropriate servicing Facility or Provider if referring to a Physician’s
office
D. Details – Additional information is required, a symbol will appear indicating that certain details are
required such as: Place of Service, Referred to Provider, Units/Frequency/Duration
Enter the Referred to Providers information
(Specialist, PT, OT, DME etc.)
Input “N/A” in “Referral Number” field
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Search for the Referred to Provider (Specialist, DME, OT, PT, etc.) by name
Select the Provider
In-Plan
Facility and patient have matching HAP Midwest Health Plan products (ex. HMP, AKM)
In-Network
Facility and patient do not have matching HAP Midwest Health Plan products
Click Next
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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In the Additional Notes accordion, add any notes or supporting documentation
Verify the Authorization Request details are correct in the right panel
Select the button in the lower right panel (hover over this button if not active)
A request confirmation will be created for each service/test
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Print a Report containing information on the request by selecting the View Request PDF link, then select
to create another Auth for the same patient or
authorization for a new patient.
to go back to the main screen to create an
Users must enter a contact phone number before the authorization request can be submitted
The user’s contact phone number is added to the authorization request as a note
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Claims
From the Dashboard the Billing Agency Administrator will be able to view and submit Provider claims by
clicking on the Claims link
To search Claims click on Search Claims
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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To Enter Claims click Enter Professional 5010 Claims
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Eligibility
From the dashboard the Billing Agency Administrator will be able to view the Eligibility of the Provider
patients by clicking on Eligibility List.
Once the Billing Agency Administrator is on the eligibility list page the Billing Agency Administrator will
select the Provider site they wish to view eligibility.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Financial Statement
From the dashboard the Billing Agency Administrator will be able to view the Financial Statements for the
Provider by clicking on Vendor Financial Statements.
Click LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Provider Contracts
From the Dashboard the Billing Agency Administrator will be able to download standard Provider
agreements by clicking on Provider Contracts.
Click LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Remittance Advice
From the Dashboard the Billing Agency Administrator will be able to download the Providers Remittance
Advice Statements by clicking on Remittance Advice.
Click LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator EDI 837 Claim Errors
From the Dashboard the Biller Agent Administrator will be able to download Provider EDI Claim Errors by
clicking on EDI 837 Claim Errors.
Click LastWriteTime in order to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator EDI 5010
From the Dashboard the Billing Agency Administrator will be able to submit Provider EDI 5010 claims
and other documents by clicking on EDI 5010
Select the type from the drop down list
Uploaded your document by click the select button. Please pay attention to the
Naming Convention, and Allowed File Extension types.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator EDI 835
From the Dashboard the Billing Agency Administrator will be able to download Provider EDI 835s by
clicking EDI 835
Click LastWriteTime to sort by date
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Pick Up 997
From the dashboard the Provider will be able to see if their EDI transaction has been acknowledge.
Please note this is not the acknowledgement of the claim but the acknowledgment of the transmittal of the
claim.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Pick Up 277CA
The purpose for the 277CA Claims Acknowledgement report (277CA) is to provide a claim-level
acknowledgement of all claims received in the front-end processing system before claims are sent into
the adjudication system.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator ICD10-Testing
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Administrator Edit Profile
Click on My Profile (Top right corner it’s hidden near your username)
Note: You will be able to view your permissions by clicking My Profile.
Click Edit to reset Password, Change Email address and Edit Security Information.
If you need to update your address and/or phone number Contact your Provider Representative.
Note: You will be able to view your permissions by clicking My Profile. If you need your
permissions changed/modified contact your Provider Administrator
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Representative Help Guide
Billing Agency Representative Registration
After you successfully register you will be emailed an activation link.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Representative Log in
Billing Agency Representative Select a Provider
From the drop down list select the Provider you wish to access
Billing Agency Representative Dashboard will appear
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Representative View Provider Access
From the dashboard the Billing Agency Representative will be able to view the access they have for each
provider they are associated with.
CONFIDENTIAL NOTICE: This communication contains information from HAP Midwest Health Plan that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This
information is intended for use only by the person to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this
communication, is strictly prohibited. If you received this in error, please contact the sending party at the above telephone number and shred, delete or otherwise destroy the information
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Billing Agency Representative Request Access
From the dashboard the Billing Agency Representative will be able to request modifications to their
permission(s) by selecting Request Access
Select the access you want and click send request
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Billing Agency Representative Email Admin
From the dashboard the Billing Agency Representative will be able to send an email to Billing Agency
Administrator. This can be used to send messages about access/permissions.
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Billing Agency Representative Switching/Changing Provider
From the dashboard the Billing Agency representative that have access to multiple Providers can click
on Select Provider to switch between Providers without having to log out and back into the portal.
From the drop down list select the Provider you wish to access
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Billing Agency Representative Authorizations and Referrals
From the dashboard the Billing Agency Representative will be able to view Provider Authorizations and
Referrals by click on Auths/Referrals
Enter search criteria
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Biller Agency Represntative Enter Auth/Referral
From the dashbaord click on Enter Auth/Referral and Clear Coverage will lauch.
Clear Coverage is a web based application, offers the ability to submit an Authorization Request/Prior
Authorization (PA) for procedures and receive an immediate, real‐time response to that request.
Once Clear Coverage launches the application will launch/load to the Clear Coverage home page.
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Entering a New Authorization using Clear Coverage
From the Clear Coverage home screen select New Authorization
In the Patient Search Accordion, search for a member by entering the subscriber ID number located on
the members HAP Midwest Health Plan card.
In the Search Results window, press the SELECT button next to the patient you are searching for
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Verify patient’s information and select the ADD TO REQUEST button
Next step is to enter the Requesting Information (Referred by Provider)
Date of Service – Date the service/rental will be performed
Users may back-date up to 3 days and future-date up to 30 days
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Select a Referred by Provider choosing the Select Other Clinician link
Type the requester name and hit serach after slecting the provider click use slelectd to add the Provider
to the authorization.
Use Selected
After verifying the Referred by Providers address and Verifying the Date of Service, select the ADD TO
REQUEST button.
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In the Diagnosis Accordion, search for billable Diagnois
A Diagnosis description or ICD9/10 can be entered
Select the ADD button, and press NEXT
In the Service Accordion, search for the Service/Test,
A service/test description or CPT/HCPCS code can be entered.
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Select the Service/Test click the ADD button, and press NEXT.
In the Service Information accordion complete the required information, then press NEXT.
A. Priority – This field defaults to Normal, but can be changed
B. Primary Diagnosis –Select the primary diagnosis from the drop down
C. Servicing Facility – Choose the appropriate servicing Facility or Provider if referring to a Physician’s
office
D. Details – Additional information is required, a symbol will appear indicating that certain details are
required such as: Place of Service, Referred to Provider, Units/Frequency/Duration
Enter the Referred to Providers information
(Specialist, PT, OT, DME etc.)
Input “N/A” in “Referral Number” field
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Search for the Referred to Provider (Specialist, DME, OT, PT, etc.) by name
Select the Provider
In-Plan
Facility and patient have matching HAP Midwest Health Plan products (ex. HMP, AKM)
In-Network
Facility and patient do not have matching HAP Midwest Health Plan products
Click Next
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In the Additional Notes accordion, add any notes or supporting documentation
Verify the Authorization Request details are correct in the right panel
Select the button in the lower right panel (hover over this button if not active)
A request confirmation will be created for each service/test
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Print a Report containing information on the request by selecting the View Request PDF link, then select
to create another Auth for the same patient or
authorization for a new patient.
to go back to the main screen to create an
Users must enter a contact phone number before the authorization request can be submitted
The user’s contact phone number is added to the authorization request as a note
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Biller Agency Representative Claims
From the Dashboard the Billing Agency Representative will be able to view and submit Provider claims
by clicking on the Claims link
To search Claims click on Search Claims
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To Enter Claims click Enter Professional 5010 Claims
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Billing Agency Representative Eligibility
From the Dashboard the Billing Agency Representative will be able to view the Eligibility of the Providers
patients by clicking on Eligibility List.
Once the Billing Agency Representative is on the eligibility list page the Billing Agency Representative will
select the Providers site they wish to view eligibility.
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Billing Agency Representative Financial Statement
From the dashboard the Billing Agency representative will be able to view the Financial Statements for
the Provider by clicking on Vendor Financial Statements.
Click LastWriteTime in order to sort by date
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Provider Agency Representative Provider Contracts
From the Dashboard the Billing Agency Representative will be able to download Standard Provider
Agreements by clicking on Provider Contracts.
Click LastWriteTime in order to sort by date
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Billing Agency Representative Remittance Advice
From the Dashboard the Billing Agency Administrator will be able to download the Providers Remittance
Advice Statements by clicking on Remittance Advice.
Click LastWriteTime in order to sort by date
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Billing Agency Representative EDI 837 Claim Errors
From the Dashboard the Biller Agent Administrator will be able to download Provider EDI Claim Errors by
clicking on EDI 837 Claim Errors.
Click LastWriteTime in order to sort by date
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Billing Agency Representative EDI 5010
From the Dashboard the Billing Agency Administrator will be able to submit Provider EDI 5010 claims
and other documents by clicking on EDI 5010
Select the type from the drop down list
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Uploaded your document by click the select button. Please pay attention to the
Naming Convention, and Allowed File Extension types.
Billing Agency Representative EDI 835
From the Dashboard the Billing Agency Administrator will be able to download Provider EDI 835s by
clicking EDI 835
Click LastWriteTime to sort by date
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Billing Agency Representative Pick Up 997
From the dashboard the Provider will be able to see if their EDI transaction has been acknowledge.
Please note this is not the acknowledgement of the claim but the acknowledgment of the transmittal of the
claim.
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Billing Agency Representative Pick Up 277CA
The purpose for the 277CA Claims Acknowledgement report (277CA) is to provide a claim-level
acknowledgement of all claims received in the front-end processing system before claims are sent into
the adjudication system.
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Billing Agency Representative ICD10-Testing
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Billing Agency Representative Edit Profile
Editing profile
Click on My Profile (Top right corner it’s hidden near your username)
Click Edit to reset Password, Change Email address and Edit Security Information.
If you need to update your address and/or phone number Contact your Provider Representative.
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Trading Partner/Submitter Help Guide
Trading Partner/Submitter Registration
After you successfully register you will be emailed an activation link
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Trading Partner/Submitter Log in
Trading Partner/Submitter Upload Documents
In order to upload documents the trading partner/submitter must click on the provider’s tab found
on at the top of the HAP Midwest Health Plan home page.
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From the dashboard the Billing Agency Representative will be able to upload EDI 5010 claims by clicking
on the EDI 5010 link
Select the document type from the drop down list
Uploaded your document by click the select button.
Please note:



Naming Convention: TestSubmitterID837
Ex: TestS4615837
Allowed File Extension: EDI
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Trading Partner/Submitter Edit Profile
Click on My Profile (Top right corner it’s hidden near your username)
Click Edit to reset Password, Change Email address and Edit Security Information. If you need to update
your address and/or phone number contact Customer Service (888) 654-2200.
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