Claims Filing Workflow

Providers are responsible for reviewing all pertinent documents in the Provider E-Library. Documents listed in the IV Therapy indices are specific to that service, however, other policies in the E-Library may also apply.

Situation	Workflow
Medicare is primary and the services have been denied	Initial claim File the claim first to Medicare. When Medicare denies send HMSA: A completed IV Therapy Cover Sheet (check Medicare Denied box) A completed claim form A copy of the EOMB Subsequent claims (Same member, therapy and treatment episode) Send HMSA: A completed IV Therapy Cover Sheet (check Medicare Denied box) A completed claim form A copy of the initial EOMB
Medicare is primary and some or all of the services are covered	File the claim first to Medicare. When Medicare makes payment send HMSA: A completed IV Therapy Cover Sheet (check Medicare Paid box) A completed claim form A copy of the EOMB
HMSA private business plan is primary (PPP and HMO)	File the claim to HMSA and include: A completed IV Therapy Cover Sheet (check HMSA Private Business plan box) A completed claim form
Medicare Advantage is primary	File the claim to HMSA and include: A completed IV Therapy Cover Sheet (check Medicare Advantage box) A completed claim form using Medicare’s codes

Send claims to:

HMSA - CMS 1500 Claims

P.O. Box 44500

Honolulu, HI 96804-4500

CURRENT AS OF 08/03/2026

Revision History

Date	Nature of Revision
08/03/2026	Migrated to new platform.