If you see this card and you participate in Priority Health's PPO network in Michigan, see this patient as you would any other Priority Health PPO member.
HMA is a Priority Health third-party administrator (TPA) product that a select few employer groups have purchased. HMA plan members use Priority Health's PPO network*, but you'll work with these members differently than you would other Priority Health members.
*There are a few exceptions for groups that have opted out, including Bronson Healthcare.
Click to expand each of the following for more information on each topic.
You won't be able to use prism's Member Inquiry to confirm eligibility or check benefits information for HMA plan members. Instead, you should call HMA's support line at 833.865.0141. If you have the HMA provider portal, you'll be able to check there for eligibility and benefits information too.
Need a prior authorization? You can call HMA's support line at 833.865.0141. The support line can also help you determine if a particular service code needs a prior authorization.
Prior authorization turnaround time for HMA members is a maximum of 15 days. HMA will send you a letter with the decision. If the authorization is denied, you'll also receive a phone call.
If you have the HMA provider portal, you'll be able to submit authorization requests there too.
Claims should be submitted to HMA, not Priority Health. HMA accepts electronic claims through Availity using payer ID HMA01. You can also submit claims via fax at 866.458.5488 or via mail to:
HMA
Attn: Claims Department
P.O. Box 85008
Bellevue, WA 98015
Please follow ICD-10 coding guidelines.
To check the status of claims, call the HMA support line at 833.865.0141 or on Availity, if you submitted the claim there. If you have the HMA provider portal, you can track claims there too.
If your claim is accepted, you'll receive a paper check for payment until you complete an enrollment form for Electronic Funds Transfer (EFT) with ECHO, HMA’s payment partner.
Providers may appeal authorization and claim denials on behalf of a member. To do so, write to HMA, including the following information:
HMA also needs a completed Appeal Submission Form signed by the member in order for the provider to appeal on behalf of the member. Without this completed and signed form, appeals will be rejected and an Appeal Submission Form will be mailed out.
You may also download and print the Appeal Submission Form and send it in via fax to 855.462.8875 or via mail to:
HMA
Attn: Appeals Department
P.O. Box 85016
Bellevue, WA 98015
Note that this appeals information is always included on claim and authorization denial documentation.
Call HMA's support line at 833.865.0141. Live representatives are available Monday–Friday, 8:00AM–9:00PM Eastern Time. Make sure when you call in that you have your NPI and your Tax ID number, as well as the member’s ID number and birth date. You should also have your fax number ready if you want the information you’re seeking faxed to you afterward.
If you have the HMA provider portal, you'll be able to submit inquiries (Express Requests) there. Response time is a maximum of 15 days. The exact amount of time depends on the complexity of the question. Over half of Express Requests are answered same-day.
Access the HMA provider portal any time at priorityhealth.com/provider/HMAproviderportal. If you don't yet have an account, you can register by clicking on the Not Registered link and go through the steps to create an account.
The HMA provider portal is used for:
For details about using the portal for each of these activities, see our HMA provider portal training guide.
Note that prism can't be used for HMA members.
See below for guidance on what tools to use and when.
Provider portal | Phone support | Availity |
|
Call 833.365.0141*Phone support includes live agent assistance Mon.-Fri., 8:00 am to 9:00 pm Eastern |
*Use payer ID HMA01. You can also fax claims to 866.458.5488 or mail them to: HMA, Attn: Claims Department, P.O. Box 85008, Bellevue, WA 98015. |
HMA members are covered for out-of-state care received from providers who participate in Cigna's Open Access Plus (OAP) network, as part of Priority Health's Strategic Alliance with Cigna. Simply follow card instructions and submit claims to HMA. See our provider manual for more information. All terms of the alliance that apply to Priority Health members also apply to HMA plan members.
HMA members who live outside of Michigan will have a member ID card with the Cigna logo on the front instead of the Priority Health logo. Note that the Priority Health logo still appears on the back of this card. See the sample card images below.
Expand the following for answers to some of our most frequently asked questions about HMA.
A third-party administrator (TPA) is a company that provides operational services, such as prior authorizations, claims processing, member support, etc. This TPA product will be administered by HMA, while the member maintains access to the Priority Health network. It is not a leased network.
We anticipate that this will be a niche product with slow growth in the market. We’re anticipating only a few thousand members the first year, primarily in the West and Southeast regions of Michigan.
Yes. This product will use our broad network PPO rates within our existing provider agreements, so your reimbursement shouldn’t be impacted.*
*Note that HMA has its own payment integrity processes.
No. If you’re a credentialed provider with Priority Health's PPO network, you’re all set to serve HMA plan members.
HMA uses Cigna’s medical policies as primary. If Cigna lacks relevant policy, HMA will turn to MCG criteria. MCG provides evidence-based guidelines for medical necessity. When Cigna does not offer a suitable policy for cancer cases, HMA will rely on the National Comprehensive Cancer Network (NCCN).
When necessary, HMA will engage AllMed Healthcare Management for independent physician review.
Yes, in some cases HMA may reach out regarding a patient's care, such as to ask for medical records, etc., in order to adjudicate claims.
Check out a short video about the HMA product.