Due to the Maui wildfires, provider requirements and services listed below have been suspended for all Maui County for services rendered through May 31, 2024. Prior authorization requirements will be reinstated for services rendered effective June 1, 2024.

• Submission and processing of precertification requests, including post-acute discharge reviews, advanced imaging, pain management, outpatient rehab therapies, chiropractic reviews through Evolent (formerly Magellan Hawaii), and behavioral health through Carelon (formerly Beacon Health Options).
• Submission of PPO/HMO administrative review requests.
• Submission of QI out-of-network reviews.
• Submission of plan-directed care requests.
• Submission of faxed admission face sheets.
• Submission of hospital census and ADTs.
• Inpatient concurrent reviews.
• Submission of supportive care requests.

For care that will start before June 1 and continue beyond that date, we encourage providers to request prior authorization to reduce possible claim processing issues.

Please proceed per best practice/standard of care guidelines and HMSA medical policies as published in the HMSA Provider Resource Center or HHIN+. HMSA reserves the right to review services on a retrospective basis and recover reimbursement if services rendered aren’t found to be medically necessary.

HMSA will continue to review out-of-state air ambulance requests.

In addition, HMSA will comply with government standards or regulations that apply to access to care during a federal disaster or other public health emergencies.

For patients receiving physical medicine (physical therapy, occupational therapy, or chiropractic) services during the waiver period:

• For providers with approved authorizations through the waiver:
  • If the validity period extends beyond May 31 and no additional care will be needed, no further action is necessary.
  • If care will be needed beyond June 1, prior authorization will be required after the current authorization period ends. Additionally, for Evolent to perform a medical necessity review, providers will need to submit the following with the request:
    • Initial evaluation
    • Progress notes
    • Daily notes

Will any information regarding the completed/waived treatment need to be submitted?

• No. Providers do not need to upload anything into their auto-approved authorization that was issued during the waiver period.