This page contains instructions on how providers can join HMSA’s provider network.
We encourage providers to participate in all the plans they're eligible for so they can serve as many HMSA members as possible. Completing your application for all of our plans at one time will eliminate the inconvenience of repeating the application and contracting process for other plans. The registration process takes 90 to 120 days after we've received all the required documents. Registration includes the HMSA Credentialing Committee's review of a provider's credentials, contracting with our networks, and issuing an HMSA Provider ID.
Be sure to print, sign, and date your forms as needed.
Before you begin, we highly recommend that you print out the Provider Registration Checklist. This checklist will help you complete your registration and ensure that you submit the required documents.
Once you print the checklist, please read the following instructions and complete the HMSA Provider Enrollment and Credentialing Application and the HMSA Authorization to Release Documents and Information and Dispute Resolution Agreement.
Complete the remaining forms (as applicable) on the Provider Registration Checklist and send them to HMSA. We can't accept incomplete applications. If any documents are missing, we'll contact you one time only. If we don't receive the documents, we'll close your application and you'll have to resubmit everything to restart the process.
QUEST Integration (Medicaid) -- HMSA Long-Term Services and Supports (LTSS) Provider Applications
Submit your completed and supporting documents in one of these ways:
Provider Data Administration, KLCR-PDA
P.O. Box 860
Honolulu, HI 96808-0860
948-8210 on Oahu.
|Rev#:||Date:||Nature of Change:|
|1.0||03/09/2017||Added the following link: HMSA Naturopathic Physician Primary Care Capability Attestation.|
|1.1||03/14/2017||Updated the Provider Data Administration contact information.|
|1.1||08/25/2017||Updated the link to the Nonparticipating provider enrollment form instructions.|
|1.2||10/05/2017||Added/updated the following links: ABA Provider Registration Checklist (previously ABA Facility Program Initial Application & Checklist); ABA Autism Clinic Credentialing Checklist (previously HMSA Behavioral Health Facility/Program Application Addendum for HMSA's ABA Qualified Provider Network); ABA Application Addendum|
|1.3||08/10/2018||Updated the Facility and Ancillary Credentialing Requirements link.|
|1.4||12/14/2018||Removed the following links: HMSA Facility Ancillary Initial Credentialing Application Form HMSA Behavioral Health Facility/Program Credentialing Document Checklist and Application Form Added the following link: HMSA Facility / Ancillary and Behavioral Health Facility Initial Credentialing Application Form|
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