Hoag Physician Partners

Hoag Physician Partners (HPP) is a comprehensive network of world-class physicians that includes primary care and more than 350 specialist physicians representing a broad range of specialties. By joining our independent physician association (IPA), you are now affiliated with the highest ranked hospital in Orange County. Hoag Physician Partners (HPP) allows patients access to the entire Hoag health care system, including Hoag Health & Wellness Centers throughout Orange County, Hoag Imaging Centers and 15 Hoag Urgent Care locations.

Benefits include:

• Capitation Payment

• Claims Payment

• Contract Administration

• Credentialing

• Eligibility Verification

• Medical Authorization

• Provider Relation Services

• Member Services

• Quality Improvement

• Utilization Management

If you are interested in joining Hoag Physician Partners, email jointhenetwork@hoag.org.

Labs

As you may know, out-of-network services, including laboratory services, are generally not covered under health maintenance organization (HMO) plans. As patients may be responsible for out-of-network costs, it is imperative that providers refer patients and send test specimens to in-network laboratories. Referring to in-network labs will also assist Hoag in providing streamlined referral/utilization review and claims experiences for our providers and patients. We appreciate our provider network’s role in providing members with positive, cost-effective laboratory service options. Our list of in-network laboratories include:

• Routine laboratory services (including but not limited to CBC, RBC, WBC, platelet count, hemoglobin, hematocrit, BMP, enzyme marker, HDL, LDL, hCG, Ammonia, CO2, ALT, SGPT, coagulation, bacterial culture, and urine culture)

  • Quest Diagnostics

  • Quest Contact Sheet

  • Quest Pathology Information

• Specialty laboratory services

  • LabCorp

  • Caris Life Sciences

  • Natera

  • Ambry Genetics

Therapy

List on Excel sheet (Therapy Vendors)

Ancillary Network

List on Excel sheet (Hoag Ancillary Network)

Pediatric Referrals

List on Excel sheet

Submitting Claims Via Office Ally

Office Ally is HPP’s preferred gateway for electronic data interchange (EDI) transactions.To register for the Office Ally Clearinghouse, visit OfficeAlly.com.

When submitting electronic claims through Office Ally, please use HPP’s payer ID code: HPPZZ.

• We encourage you to submit claims electronically, whether you have a small or large practice.

• Submitting claims electronically can help your office turn around claims faster, reduce denials and help improve cash flow.

To submit claims by mail, please send to:

Hoag Physician Partners P.O. Box 1260 Costa Mesa, CA 92626

EFT-ERA Payments

To sign up for EFT-ERA Enrollment a separate enrollment form must be completed for every Tax ID you wish to set up, for each individual insurance company (Payer) you want to enroll. For example, if you work with 10 Payers, ECHO will need 10 enrollment forms with the individual Payer name included on each form. There is no fee for this program.

Please allow 7-10 days for processing, please be advised that enrollments requiring additional validation may take longer to complete.Instructions for the EpicLink Remittances:

• A PDF remittance advice document can be found within Remittance Advice Search in EpicLink

• Search via Claim ID, Member ID, or Provider in EpicLink

• Select the hyperlink within the Check Number PDF of Remittance Advice

• The link will open and will be available to print or download

EFT-ERA Enrollment Form

Treatment Authorization

Treatment Authorization Form

The treatment authorization form should be used when you are unable to access EpicLink and need to submit an authorization immediately.

IMPORTANT NOTE: if a member is missing from EpicLink, please fill out an online member add form located here. A member add form will be needed for authorization requests in EpicLink and requests using the Treatment Authorization form. If you have access to EpicLink, it is highly recommended that you fill out the member add form and, once the member has been added, use EpicLink to request the authorization.

If you need access to EpicLink, please request access here. Once your access has been provisioned, please use EpicLink for all authorization requests.

Please send to the appropriate number according to authorization priority.

• Routine/Standard Requests: 949-791-3491

• Urgent/Expedited Requests: 949-791-3492

• Inpatient Admission Notification: 949-791-3489

Treatment Authorization Form

To find an In network HPP provider, please use: hoaghealth.org or click here for the HPP Provider Directory.

Frequently Asked Questions

Q: How long will it take for a determination to be made on a referral?

Q: In what instances would we use urgent as a priority? A: Urgent should be used for medical necessity, not patient preference of a patient to get something approved quicker.

Q: How do we submit authorization request? A: Preferred method – EpicLink, Fax – Complete the treatment authorization form and fax to the appropriate department.

Q: What is the quickest way to check the status of a referral? A: You can check the status of a referral on EpicLink

Q: The doctor has not finished their note documentation. Do I need to wait for the clinical documentation before submitting a referral request? A: You can submit the referral request without clinical documentation but we do not recommend it. If we do not receive proper clinical documentation, we will not be able to review the referral which may lead to a denial. We will call to obtain records if possible which will result in unnecessary burden on your office staff and delay a determination being made.

Q: The referral we submitted was denied but the doctor would like to discuss further. What steps do we take? A: A peer to peer can be requested on any denial. The contact information for our MD reviewer will be on the letter generated to you or you may call us at 949-791-3502 to request.

Q: What criteria does UM to make a determination on a referral? A: After determining eligibility and benefit coverage, UM makes determinations based on medical necessity. Listed below is the hierarchy that is used:

Medicare Advantage Plans:

• Plan Eligibility, Benefits and Coverage (Evidence of Coverage)

• Center for Medicare and Medicaid Services (CMS) National Coverage Determinations (NCDs)

  • Local Coverage Determinations (LCDs) or State Specific Mandates (Commercial)

  • Local Coverage Medical Policy Articles (LCAs)

  • Medicare Benefit/Coverage Policy Manual

  • Medicare Claims Processing Manual

  • Medicare Managed Care Manual

  • Medicare Program Integrity Manual

• CMS Drug Compendia

• Health Plan Coverage Medical Polices (as applicable)

• Milliman Care Guidelines (MCG)

• National Comprehensive Cancer Network Guidelines (NCCN)

• Diagnostic and Statistical Manual of Mental Disorders (DSM V)

• American Society of Addiction Medicine (ASAM)

• Hayes Health Technology Website (https://www.hayesinc.com)

• RedBook/Micromedex

Commercial:

• Plan Eligibility, Benefits and Coverage (Evidence of Coverage)

• Health Plan Coverage Medical Polices (as applicable)

• Milliman Care Guidelines (MCG)

• National Comprehensive Cancer Network Guidelines (NCCN)

• Diagnostic and Statistical Manual of Mental Disorders (DSM V)

• American Society of Addiction Medicine (ASAM)

• Hayes Health Technology Website (https://www.hayesinc.com)

• RedBook/Micromedex

Authorization Approval Policies A detailed breakdown of our policies is available on EpicLink.

Current policies and procedures are available on EpicCare Link

To access the Hoag Physician Partners Provider Manual, click here.

To access the HealthPlan Language Assistance Program (LAP) Resources, click here.

Hoag participates in various health plan Value-Based Programs (VBP) in addition to the Align.Measure.Perform. (AMP) program which is overseen by the Integrated Healthcare Association (IHA). Within those VBP, Hoag Clinic’s Quality Improvement team focuses on HEDIS measures performance, which include chronic disease management, prevention and screening, prenatal care, medication management, and utilization of specific procedures and care settings.

HPP physicians can access Cozeva for quality improvement patient gaps.

• HPP Cozeva Training

For Cozeva access requests, please email us at HoagClinicQI@hoag.org.

CPT 2 Coding guide

• CPT II Codes – (CPT II Codes Flyer_FINAL)

U.S. Preventive Services Task Force

The U.S. Preventive Services Task Force (USPSTF) provides evidence-based recommendations to guide clinical preventive care, helping to enhance patient outcomes through informed screening, counseling, and preventive interventions. These guidelines are developed by experts and are designed to assist physicians in delivering consistent, high-quality preventive services. To learn more about integrating these valuable recommendations into your practice, please feel free to refer to the full USPSTF guidelines directly at the link below.

https://www.uspreventiveservicestaskforce.org/uspstf/

Providers may direct any questions regarding the above guidelines to HPP.Providers@hoag.org.

Education pocket cards

• Pediatric quality pocket card

• Family medicine/internal medicine pocket card

• OB/GYN pocket card

Screening Questionnaires

• 8051 PHQ-9 Questionnaire Adolescents

• 8050-S Patient Health Questionnaire PHQ-9 (Spanish)

• 8050-C Patient Health Questionnaire PHQ-9 (Chinese)

• 8050 Patient Health Questionnaire PHQ-9

• 8050-V Patient Health Questionnaire PHQ-9 (Vietnamese)

• 8051-S PHQ-9 Questionnaire Adolescents (Spanish)

• 8051-TC PHQ-9 Questionnaire Adolescents (Traditional Chinese)

• 8051-V PHQ-9 Questionnaire Adolescents (Vietnamese)

Immunization Recommendations

Public link – https://www.cdc.gov/vaccines/

Contact

Hoag Clinic Quality Improvement Department – HoagClinicQI@hoag.org

Annual Health Assessment (AHA)

• HPP Annual Health Assessment Physician Reference Document

• PHQ-9 Patient Health Questionnaire

• PHQ-9 Patient Health Questionnaire (Spanish)

• PHQ-9 Questionnaire Scorecard

• GAD-7 Screen

• Annual Visit Questionnaire Form

• Annual Visit Questionnaire Form(Spanish)

• Annual Visit Questionnaire Form (Chinese)

• Annual Visit Questionnaire Form (Traditional Chinese)

• United States Preventive Services Task Force (USPSTF) Recommendations

Educational Information

There are no current updates on any educational information at this time. For any questions pertaining to risk adjustment, please contact:

Christina Cabiltes at Christina.Cabiltes@hoag.org or (949) 791-3432

Coding Guidelines and Updates

These guidelines are updated on a monthly basis. Each provider will receive a PowerPoint presentation through email.For further questions or clarification, please contact:

Jennifer Clayton at Jennifer.Clayton@hoag.org

HCC Reference Sheet

Secure File Transfer

Link: https://sft.hoag.org

Every provider has an individual SFTP link, please reach out to Christina Cabiltes at Christina.Cabiltes@hoag.org or (949) 791-3432 for your direct url.

HPP Events

You can find webinars available for Continuing Medical Education (CME) credit by visiting www.hoag.org/cme. For assistance with CME (Continuing Medical Education) login credentials, please contact Diane Yoon at diane.yoon@hoag.org.

If you need the direct video link that was sent to you, please contact HPP.Providers@hoag.org.

Contact

HPP.Providers@hoag.org or (949) 791-3502 for more information about these events.