News & Media
Reimbursement Advocacy Alert: January 2026
HAP CareSource Continues to Offer Medicaid and MI Coordinated Health Plans in Michigan for 2026 and Beyond
HAP CareSource continues to provide Medicaid, Healthy Michigan Plan and Children Special Health Care Services (CSHCS) and HAP CareSource™ Michigan Coordinated Health (MICH) plans. HAP CareSource offers Medicaid in 19 counties (within Prosperity Regions 6,7,9 and 10) and Michigan Coordinated Health in Wayne and Macomb counties for 2026.
In the fall, HAP CareSource reported that they would not be offering their Marketplace plan on the ACA exchange in 2026. That is the ONLY plan impacted. HAP CareSource reports they are committed to customers in Michigan.
HAP CareSource Medicaid and MICH members can still access their full network here.
- If you are a HAP CareSource Medicaid provider who has questions, call 1-833-230-2102, Monday through Friday, 8:00 am to 6:00 pm.
- If you are a HAP CareSource Michigan Coordinated Health provider who has questions, call 1-833- 230-2159, Monday through Friday from 8:00 am to 6:00 pm.
Update - Incentive for 2025 HEDIS Gap Closure Extended Through January
HAP is offering a $50 incentive for each HEDIS care gap closure submitted via the HAP portal from October 20, 2025, through January 31, 2026. This incentive is applicable to Medicare Advantage submissions only. Earned incentives will be paid at the end of the first quarter of 2026. The following HEDIS measures are eligible for the submission incentive:
- Hemoglobin A1c <8%
- Hemoglobin A1c ≤9%
- Controlling high blood pressure
- Breast cancer screening
- Colorectal cancer screening
- Diabetic eye exam
HAP reserves the right to exclude any data submission from the incentive that is not accurate or does not close a HEDIS care gap for measurement year 2025.
The following HEDIS measure is not included in the incentive but is still encouraged for data submission through the HAP portal:
- Cervical cancer screening
Below are instructions for submitting data online to close HEDIS gaps. A medical record is required upon submission and to receive the incentive.
- Log in at hap.org and select HEDIS and HCC Program.
- Enter a member ID or select the link to view your HCC/HEDIS Gaps PanelManagement Report.
- Select a gap with “eligible” next to it. Click the “Update” button.
- Complete the fields.
- Attach the appropriate information from the medical record (required).
- After your submission, the status will change to “submission in review.”
- If approved, the status will change to “submission approved.”
- If denied, the status will change to “submission denied.” Practices can view the denial reason. They will also send an email with the denied reason. Offices can resubmit information to close the gap
McLaren Health Plan - Upcoming Preauthorization Changes Effective March 1, 2026
Please be advised that preauthorization requirements will change for Medicaid/Healthy Michigan, Marketplace, and Health Advantage plans, unless otherwise noted, effective March 1, 2026. These updates are intended to ensure continued compliance with coverage guidelines. The list of changes is available here.
WPS Update
2026 Physician Fee Schedules Available
The 2026 Physician Fee Schedules (PFS) and Anesthesia Conversion Factors (ACF) are available on the WPS website. Practices can access the 2026 Physician Fee Schedules (PFS) here and the Anesthesia Conversion Factors from the 2026 Specialty Pricing webpage.
CMS Updates
ICD-10-PCS: CMS Announces 80 New Codes, Effective April 1
Visit the ICD-10 webpage to get April 2026 procedure code update files. Use these codes for discharges and patient encounters occurring from April 1 – September 30, 2026.
Health Professional Shortage Area: CY 2026 Bonus Payments
See ZIP Codes designated as Health Professional Shortage Areas in 2026 that are eligible for a Medicare Physician Bonus:
See the instruction to your Medicare Administrative Contractor (PDF).
Doctors & Clinicians: CY 2023 Performance Information
CMS added CY 2023 Quality Payment Program performance information to the Provider Data Catalog and the clinician and group profile pages on the Medicare.gov compare tool. Visit the Care Compare: Doctors and Clinicians Initiative webpage for more information.
2026 CMS Burden Reduction Conference – February 25
Wednesday, February 25, 2026, from 9:00 am – 1:00 pm
Register to attend in-person at the Hubert H. Humphrey Building in Washington, DC or virtually. In-person attendance is limited due to space. This hybrid conference convenes leadership from the federal government, health provider organizations, and patient advocates to focus on opportunities across the health care enterprise to reduce administrative burden and strengthen access to quality care, improving the health care experience for clinicians and patients.