Frequently Asked Questions: Claims

CMS has announced that some of the new CMS-1500 forms are incorrectly formatted. Will HMSA be able to process claims submitted on these forms?

This issue will not impact HMSA’s CMS-1500 acceptance timeline. HMSA will be able to accept the misaligned forms as well as correctly formatted forms.

How can I authorize another person to sign claims on my behalf?

Hard-copy claims require the signature of the physician or practitioner providing the service. However, some practitioners prefer to delegate this function to office staff. If this is your intent, please complete an Agent Authorization form and fax it to HMSA at 808-948-6887 on Oahu.

Where should I send my claims?

Different claim types are submitted to various post office boxes. For example, QUEST, BlueCard and FEP claims are submitted to different post office boxes than the P.O. boxes for HMSA’s private business plans claims. To determine the appropriate address for your claims, see the HMSA Directory – Claims.

If I don’t understand how a claim was processed, whom should I contact?

If you would like more information about the processing of a complex claim, call a Provider Teleservice Representative at 808-948-6330 on Oahu or 1-800-790-4672 from the Neighbor Islands.

You may also inquire in writing at:

HMSA – Provider Operations

Attn: Research and Correspondence

P.O. Box 860

Honolulu, HI  96808-0860

How do I include sales tax on a claim?

A provider may choose whether or not to bill for tax. If the provider bills for tax, HCPCS code S9999 should be used to identify the tax. The use of this code applies to both electronic and hard-copy claims.

How can I check the status of a claim?

You should begin by carefully reviewing your Report to Provider. Check all pages of the report. If the claim is not shown on the Approved page, it may be on the Adjusted page, the Denied page or the Claims in Process page. If a claim is listed on the Claims in Process page, HMSA has received the claim and is processing it. You do not need to follow up.

If you subscribe to the Hawaii Healthcare Information Network (HHIN+) you can also check the status of your claims, verify eligibility and do much more. If you do not currently subscribe to HHIN+, we encourage you to call the HHIN+ Help Desk at 808-948-6446 on Oahu or 1-800-760-4672 from the Neighbor Islands.

How do I resubmit a claim?

Instructions for resubmitting a claim are available in the Provider E-Library at Verifying Claim Status and Resubmission of Processed Claims (CMS-1500).

How do I submit a multi-page claim?

When you are billing for multiple services rendered to the same patient during the same encounter, you may exceed the number of available service lines (six) on the CMS 1500 claim form. When this occurs, you may file a multi-page claim as instructed in Multi – page Claims.

Where can I purchase claim forms locally?

HMSA has secured special prices from local vendors for CMS 1500 forms for our participating providers. To take advantage of special rates, mention that you are an HMSA participating provider. Click the link below to view this list of local vendors.

What are the printing requirements for hard-copy claims?

Hard-copy claims should be printed on a clean CMS 1500 claim form. Keep in mind the following tips when choosing font size and type:

• Use Arial or Times New Roman fonts.
• Use font sizes 10 through 12.
• Use all upper-case letters, rather than a combination of upper- and-lower case letters. This is the community standard for claims completion.

Note: Dot-matrix printers may produce characters that are fuzzy and difficult to read. Please review your printed claims to ensure that the printed output is of high quality and the printed characters are sharp and clear.

Although handwritten claims are accepted, such claims must be entered manually, increasing the possibility of keystroke errors and lengthening the processing time for those types of claims. Typed or computer-printed claims are preferred.

Do not submit hard-copy claims as follows:

• With areas highlighted. The OCR scanner cannot read portions of the claim that are highlighted.
• Handwritten or printed with red ink. The OCR scanner cannot read portions of the claim that are handwritten or printed in red ink.
• With lines that are “squeezed” together. Do not double-up or try to squeeze in two lines to conserve space. The OCR scanner cannot read fields with more than one line of information.

For more tips on preparing claims, see CMS 1500 Claims Filing Highlights.

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