Decorative arrowsHMSA Provider Resource Center
HomeNews and AlertsE-LibraryMedicare E-LibraryCommunications ArchiveQUEST Integration
Frequently Asked QuestionsUseful Web SitesContacting HMSA

Go up one level

Pharmacies Participating With HMSA's Drug Plans

Claims Filing

Doing Business With HMSA

Medicare Part D Prescription Drug Coverage

Pharmacy Benefit Policies


Document Name:Document Number:
Birth Date Editpel.rx.BIR.500
Change of Ownership, Name, Service Sites, Bankruptcypel.rx.CHA.500
Claims Filing for Long-Term Care Pharmacy Providerspel.rx.CLA.250
Claims Processing - Edits and Messagingpel.rx.CLA.700
Coordination of Benefits for Pharmacy Servicespel.rx.COO.750
Coordination of Benefits - HMSA and Another Carrierpel.rx.COO.300
Coordination of Benefits - HMSA and Medicare Plans - Pharmacypel.rx.COO.450
Coordination of Benefits - Medicare Part D Planspel.rx.COO.500
Coordination of Benefits - Two HMSA Planspel.rx.COO.600
CVS Caremark Pharmacy Benefit Drug Prior Authorization Formspel.rx.CVS.500
CVS Caremark Pharmacy Help Deskpel.rx.PRU.500
CVS Drug Cost Tool – Member and Provider Information on real time benefitspel.rx.RTB.200
Dispense as Written (DAW)pel.rx.DIS.400
Dispense as Written (DAW) Documentationpel.rx.DIS.500
Drug Report to Member Auditspel.rx.DRU.300
Drug Utilization Reviewpel.rx.CON.700
Electronic Claims Filingpel.aa.ELE.600
Entering Compound Drugspel.rx.ENT.300
Entering Days' Supplypel.rx.ENT.400
Entering Member Informationpel.rx.ENT.500
Fee Schedule Requestpel.aa.FEE.400
Formularies for Medicare Advantage Plansdr.02.02
Gender-Specific Drugspel.rx.GEN.400
Hard Copy Drug Claims Submissionpel.rx.HAR.700
HHIN Documents & Informationhhin-prc-home
HMSA's Essential Drug Formulary and Coverage Codesdr.02.essential
HMSA's Metallic Drug Formulary and Coverage Codesdr.02.metallic
HMSA's Online Pharmacy Claims Processing Systempel.rx.HMS.600
HMSA's Optimal Drug Formulary and Coverage Codesdr.02.optimal
HMSA's QUEST Integration Drug Formularydr.02.QI-formulary
HMSA's Select and Choice Drug Formulary and Coverage Codes, and Childrens
HMSA Drug Planspel.rx.HMS.300
Insulins - Preferredpel.rx.PRE.700
Lost or Stolen Prescriptionspel.rx.LOS.500
Mandatory Generic Reimbursement (MGR) for Brand Drugspel.rx.MAN.600
Maximum Allowable Charge (MAC) Fees for Generic Drugspel.rx.MAX.500
Maximum Allowable Charge Reviewspel.rx.MAX.600
Medical Management, Quality Assurance and Other Programspel.rx.MED.350
Medicare Memberspel.aa.MED.550
Medicare Part D Prescription Drug Coverage Exclusionspel.rx.65C.700
Medicare Part D Report to Member (RTM)pel.rx.REP.400
Medicare Rx Plan Overviewpel.rx.MED.700
Medication Therapy Management: Billing Code Changespel.aa.MED.770
Medication Therapy Management Programpel.rx.MED.800
Member Eligibility Resourcespel.rx.MEM.200
Membership Connectionpel.aa.MEM.850
Motor Vehicle Insurancepel.aa.MOT.500
Nexavar (Sorafenib)pel.aa.NEX.550x
Opioid Antitussive Quantity Limits and Opioid Quantity Limitspel.rx.OPI.100
OxyContin (Oxycodone HCI Controlled Release)pel.rx.OXY.600
Payment Determination Criteriapel.aa.PAY.500
Payment of Taxpel.rx.PAY.600
Payment Transformation Annual Provider Surveypel.aa.PAY.351
Point of Sale Claims Transmissionpel.rx.POI.500
Prescription and Order Documentationpel.rx.PRE.750
Prompt Payment of Clean Claimspel.aa.PRO.500
Proof of Delivery of Servicespel.rx.PRO.400
QNXT Pay Cyclepel.aa.QNX.100
QUEST Emergency Refillspel.rx.QUE.700
Record Retention for Part Dpel.rx.REC.500
Refill Too Soon Editpel.rx.REF.800
RESTASIS® Quantity Limitpel.rx.RES.500
Screening for Food and Drug Allergiespel.rx.SCR.500
Solodyn Step Therapypel.rx.SOL.100
Specialist & Hospital Payment Transformation - Webinarpel.aa.PAY.350
Termination of a Participating Pharmacy Agreementpel.rx.TER.400
Third Party Liabilitypel.aa.THI.500
Time Periods for Submission of Claimspel.rx.TIM.500
Transition Fillpel.rx.TRA.600
UCF Instructions - Long Formpel.rx.UCF.500
Updating Your Provider Recordpel.aa.UPD.500
Using the Drug Plan Copayments Look-up Toolpel.rx.USI.500
Vaccine Storage and Handling Recommendationspel.aa.VAC.650
Workers' Compensationpel.aa.WOR.500

Files that are in PDF format can be viewed using the free Adobe Reader or another PDF-reader application.

Decorative arrowsHomeNews and AlertsE-LibraryMedicare E-LibraryCommunications ArchiveQUEST IntegrationFrequently Asked QuestionsUseful Web SitesContacting HMSA

Non-discrimination notice

Need a language interpreter?

ʻŌlelo Hawaiʻi | Bisaya | 繁體中文 | Ilokano | 日本語 | 한국어 | ພາສາລາວ | Kajin Ṃajōḷ | Lokaiahn Pohnpei | Gagana Sāmoa | Español | Tagalog | Tonga | Foosun Chuuk | Tiếng Việt