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Payment and Appeal Information

 

 

Participating providers who submit claims will receive a Report to Provider when a claim is processed. If there's a benefit overpayment, claim timeliness issues, or other concerns (e.g., genetic testing codes, additional vaccine payments), we'll provide you with an explanation.

 

If you disagree with the payment determination, we have an appeals process for providers and members.

 

Need more information? We're here to help. If you don't find what you need from the links listed below, please call Provider Services for payment questions at 948-6820 on Oahu or 1-877-304-4672 toll-free on the Neighbor Islands. If you have questions about appeals, call Member Advocacy and Appeals at 948-5090 on Oahu or 1-800-462-2085 toll-free on the Neighbor Islands.

 

Payment
 
Reimbursing HMSA, Refunds
 
ALL "PAYMENT, REPORTS AND APPEALS" DOCUMENTS:
 
Document Name:Document Number:
Akamai Advantage and 65C Plus Contracted Provider Appealspel.aa.65C.200
Akamai Advantage Non-Contracted Provider Appealspel.aa.AKA.201
Appealing a Pre-Certification Denialpel.aa.APP.400
Appealing Processed Claimspel.aa.APP.500
Arbitrationpel.aa.ARB.500
Benefit Overpaymentpel.aa.BEN.500
Benefit Overpayment - Senior Planspel.aa.BEN.502
Claims Timeliness Standardspel.aa.CLA.900
Coding Reviews of E/M Servicespel.aa.COD.800
Fee Reviewspel.ph.FEE.500
Fraudpel.aa.FRA.500
Genetic Testing Codespel.aa.GEN.100
Non-Physician Appealing a Precertified Denialpel.aa.NON.250
Non-physician Appeals (Excluding Facilities)pel.aa.NON.700
Payment Determination Criteriapel.aa.PAY.500
Payment Transformation Annual Provider Surveypel.aa.PAY.351
Physician Appealing a Precertification Denialpel.aa.PHY.300
Physician Appealspel.aa.PHY.200
Reimbursing HMSApel.aa.REI.500
Report to Providerpel.aa.REP.500
Specialist & Hospital Payment Transformation - Webinarpel.aa.PAY.350
Vaccine Additional Payment Requestpel.aa.VAC.500
 

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

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