If you’re currently seeing a provider outside of Hawaii or a nonparticipating provider for therapy services, it is your responsibility to ask the provider to submit a precertification request for any services.
If you’re an HMO member, your primary care provider (PCP) will need to submit an Administrative Review (AR) request for therapy services that will be rendered by any nonparticipating or out-of-state therapist. If the AR request is approved, the nonparticipating or out-of-state therapist can request precertification from Landmark Healthcare (the company HMSA uses to manage therapy precertification requests). All services rendered by nonparticipating and out-of-state providers for HMO members without an AR approval will be denied.
If you are expecting to receive therapy from a nonparticipating provider, please print the appropriate form below and ask your provider to complete it. Send the form to Landmark Healthcare using the fax number or mailing address indicated at the top of each form.