Forms and other information

We want it to be easy for you to work with HAP. Here are forms you'll need:

Claims Appeals Form

Provider Change Form

• Provider Change Form - update existing provider information.

Inpatient Rehab and Skilled Nursing Facility Forms

• Inpt Rehab SNF-Admission Precert
• Inpt Rehab SNF-Continued Stay or Auth Discharge Summary
• Inpt Rehab SNF-LTAC Continued Stay Auth
• Inpt Rehab SNF-Wound Care Summary

Prior Authorization information

• Prior Authorization Reform
• Prior Authorization Requirements

Non-contracted Providers

Looking to become a HAP provider? Learn more.

After Hours and Appointment Time Access Standards

Facility and medical record standards

• Facility Standards for Practitioners and Providers
• Medical Record Standards for Practitioners and Providers

Contact Us

Customer service

Commercial
(800) 422-4641
HAP Senior Plus®
(800) 801-1770 TTY: 711
HAP Senior Plus® (PPO)
(888) 658-2536 TTY: 711
Alliance Medicare Supplement:
(800) 873-7526 TTY: 711

Individual and family plans
Ready to join?
(855) 948-4427
HMO Plans
(800) 759-3436
PPO Plans
(800) 944-9399

Alliance Health and Life Insurance Company
(888) 999-4347
Self-funded / ASO
(866) 766-4709
HAP HMO
(800) 422-4641
HAP Empowered
(888) 654-2200