HPP Resources

Annual Health Assessment (AHA)

Enrollment and Eligibility

IMPORTANT NOTE: Before requesting a patient be added to EpicLink, please search for the patient in EpicLink under Member Search, which will allow you to search by last name, first name, or date of birth. The Eligibility Search option will require a Member ID and should not be used to verify if the member is in EpicLink.
 
To request a patient be added to EpicLink, click here
  • Please verify the patient’s eligibility with the health plan before filling out this form.
  • Eligibility adds will be completed by the next business day. If this is an urgent request, please also email eligibility@hoag.org.

Health Plan Information

Contracted Health Plans

Commercial Plans

  • Aetna US Healthcare
  • Aetna Value Network
  • Anthem Blue Cross
  • Anthem Priority Select HMO
  • Blue Shield
  • Blue Shield Trio
  • Cigna
  • Cigna Select Network
  • United HealthCare

Senior Plans

  • Anthem Blue Cross
  • Blue Shield 
  • SCAN
  • United Healthcare
  • United Healthcare Focus

Health Plan Verification Links

Anthem Blue Cross (HMO, POS, POS Sr.)Aetna (HMO, POS)

Blue Shield (HMO, POS, Medicare)

Cigna (HMO, POS)

SCAN (Medicare)

United (HMO, POS, Medicare)

Please contact (949)791-3502 for additional questions or assistance.

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

FAQs

Q: What is the turn around time to resolve a claims provider dispute? 
A: 45 working days. 

Q: How do I submit a provider dispute?
A: Submit a written dispute to: PO Box 2010, Costa Mesa, CA 92628

Q: What is the Provider dispute contact phone?
A: 1-855-539-0841

Q: Who can I contact with additional questions?
A: Please reach out by phone: 1-855-538-0841

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

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

 

Frequently Asked Questions

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

Language Assistance Services

Language Assistance Services

Provider Manual

Provider Manual 2023

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  

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

If you need additional assistance or have questions please contact us

Please note that the information contained on this page may be privileged and confidential.