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Learn About HMSA’s Network

 

 

Learn about HMSA and how to join our provider network. Then, please apply to HMSA's network.

 

 

About HMSA

Caring for the people of Hawaii is our promise and our privilege. Working together with employers, partners, and physicians and other health care providers, we promote wellness; develop reliable, affordable health plans; and support members with clear, thoughtful guidance.

HMSA is the most experienced health plan in the state, covering more than half of Hawaii's population. As a recognized leader, we embrace our responsibility to strengthen the health and well-being of our community.

Headquartered on Oahu with centers statewide to serve our members, HMSA is an independent licensee of the Blue Cross and Blue Shield Association.

 

HMSA Plans

HMSA offers a variety of plans to individual and employer groups. Providers receive payment from HMSA when they render services to members who are enrolled in the plans the provider participates in. View the HMSA Plan Overview to determine which plans you're eligible to participate in based on your provider designation.

 

Registering With HMSA

HMSA encourages 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 HMSA 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.

Learn the details of the application process and apply to join our network here.

 

Provider Contracts

Once the registration process is complete and verified accurate, HMSA will mail you the appropriate contracts. HMSA offers contracts to individual and group providers for a variety of plans including Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), HMSA Akamai Advantage (Medicare) plans, HMSA QUEST Integration (Medicaid), Special Vision, and Dental. You can view sample contracts for these plans here.

When you receive the contract, review it for the lines of business that you requested. Sign and return the contract to HMSA within 14 days of receiving it. Contracts that are returned after 14 days will result in a delay in processing your application, which may affect the effective date of your participating provider agreement.

When we receive your original signed contract, we'll hold it until the credentialing process is complete. Your participating provider status and contract effective date will be effective when we make a decision about your credentialing status. Prior to the credentialing approval date, you may register as a nonparticipating provider and submit claims on behalf of HMSA members. Claims for the PPO, HMO, and 65C Plus programs will be reimbursed to the member. Claims for HMSA Akamai Advantage will be paid directly to you if you're enrolled with Medicare. HMSA QUEST Integration doesn't accept nonparticipating providers.

When the Credentialing Committee completes its review, we'll give you an HMSA provider number, participating status, and effective date of your participating provider status. The contract effective date will be the same as the Credentialing Committee's approval date or a subsequent date that you and HMSA will agree on.

If the Credentialing Committee doesn't accept your application, we'll assign you a nonparticipating provider number that you may use to submit claims for services rendered to HMSA members. Please contact your Provider Services representative for details.

 

Provider Resources

Participating with HMSA is more than just getting paid for caring for HMSA members. We offer a variety of resources for providers:

If you have any questions, call a Provider Teleservice representative at 948-6330 on Oahu or 1-800-790-4672 toll-free on the Neighbor Islands.

 

Thank you for your interest in joining HMSA as a participating provider.

 

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