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.
|Reimbursing HMSA, Refunds|
|ALL "PAYMENT, REPORTS AND APPEALS" DOCUMENTS:|
|Document Name:||Document Number:|
|Akamai Advantage and 65C Plus Contracted Provider Appeals||pel.aa.65C.200|
|Akamai Advantage Non-Contracted Provider Appeals||pel.aa.AKA.201|
|Appealing a Pre-Certification Denial||pel.aa.APP.400|
|Appealing Processed Claims||pel.aa.APP.500|
|Benefit Overpayment - Senior Plans||pel.aa.BEN.502|
|Claims Timeliness Standards||pel.aa.CLA.900|
|Coding Reviews of E/M Services||pel.aa.COD.800|
|Genetic Testing Codes||pel.aa.GEN.100|
|Non-Physician Appealing a Precertified Denial||pel.aa.NON.250|
|Non-physician Appeals (Excluding Facilities)||pel.aa.NON.700|
|Payment Determination Criteria||pel.aa.PAY.500|
|Payment Transformation Annual Provider Survey||pel.aa.PAY.351|
|Physician Appealing a Precertification Denial||pel.aa.PHY.300|
|Report to Provider||pel.aa.REP.500|
|Specialist & Hospital Payment Transformation - Webinar||pel.aa.PAY.350|
|Vaccine Additional Payment Request||pel.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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