HMSA’s Maximum Allowable Charges (MAC’s) for PPO, HMO, and QUEST plans are located online through our Hawaii Healthcare Information Network (HHIN+). Simply log on to HHIN+, click on the FEE SCHEDULES button located at the lower right-hand side of the HHIN+ home page. https://hhinplus.hmsa.com/HHINPlus/login.
To register for new HHIN+ access, contact the HMSA Electronic Transaction Services Outreach Unit at 808-948-6255, or click here: https://hhinplus.hmsa.com/HHINPlus/ContactETS. For more information about HHIN+ please visit HHIN+ Documents & Information.
Reference this table to determine which fee schedule to use.
| Fee Schedule | Plan | Applies To* |
|---|---|---|
| HMSA HMO/FED MAC | HMO/FED | Primary care providers and clinical support providers, including general medicine, pediatrics, nursing, nutrition, audiology, and advanced practice clinicians |
| HMSA PPO MAC | PPO | |
| HMSA HMO/FED MAC SPL | HMO/FED | Specialty and advanced care providers across medical, surgical, behavioral, and diagnostic disciplines, including general surgery, pediatrics, psychiatry, oncology, cardiology, radiology, rehabilitation, and clinical therapy services |
| HMSA PPO MAC SPL | PPO | |
| HMSA HMO/FED CAM PROVIDERS | HMO/FED | Complementary and alternative medicine providers: acupuncturists, chiropractors, naturopaths |
| HMSA PPO CAM PROVIDERS | PPO | |
| HMSA PPO NEG RHC/FQHC ALLIED | PPO | Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) |
| HMSA QUEST Non-ABD | QUEST | Providers serving non-ABD (non-Aged, Blind, or Disabled) QUEST members |
| HMSA QUEST ABD | QUEST | Providers servicing ABD (Aged, Blind, or Disabled) QUEST members |
| HMSA QI Professional Fee Schedule (Memo-QI-2341) | QUEST | Physicians, mental health providers, APRNs, and PAs, regardless of ABD status. Please see Memo-QI-2341 [PDF] for details on provider types and services. |
*Please note: While these fee schedules generally align with the above criteria, exceptions may apply within each schedule.
The information provided in these fee schedules is intended for general reference only. While we strive to ensure accuracy and completeness, the data may be subject to updates, corrections, or technical issues.
The appearance of a particular procedure code on this list does not guarantee payment. Payment is subject to the member’s eligibility at the time of service, the benefits and limitations of the member’s plan, and HMSA’s benefit and payment policies. HMSA also reserves the right to review and update fees retrospectively.
Please review your contracts for further details.
Akamai Advantage rates: Medicare fees can be found either on the CMS or Noridian websites.
HMSA has implemented fee differentials above certain commercial fee schedules for certain providers as follows:
- PPO and HMO/FED MAC Schedules: Participating PCPs who physically render covered services to HMSA commercial members on Hawaii Island, Maui, Molokai, Lanai, and Kauai.
- PPO and HMO/FED MAC SPL: Participating specialists who physically render covered specialty services to HMSA commercial members on Maui.
Fee differentials do not apply to cost-based items or services that do not have an established fee under the fee schedules.
The fee differentials, including the availability and the percentage or amount of any such fee differentials, are provided at HMSA’s sole discretion. HMSA has full and sole discretion to adjust or eliminate any fee differential at any time, effective immediately. HMSA’s fee schedules are not adjusted or otherwise impacted by implementation of a fee differential.
Fee Schedule Requests
If the fee for a specific code is not listed on the fee schedule, providers may submit a written request. The request should be formatted as follows:
Provider Name:
Provider ID:
Specialty:
Line of Business: PPO, HMO, and QUEST Integration
| Procedure Code | Modifier | HMSA’s MAC |
|---|---|---|
| 71010 | 26 |
- Codes should be listed individually with modifiers when applicable.
- The column, HMSA’s MAC, should be left blank as it will be completed by HMSA staff.
- Written Requests can be submitted via:
- E-mail: E-mail a Microsoft Excel file to PS_PIU@HMSA.com