Apply to HMSA

This page contains instructions on how providers can join HMSA’s provider network.

HMSA’s Online Provider Application transition to HHIN+

We have transitioned all of our participating and non-participating, provider and facility/Long-Term Services & Support (LTSS) applications to HHIN+. Effective 12/1/2024, HMSA will no longer accept the PDF or paper copy of the application if it is on HHIN+.You will be able to access the online application from our HHIN+ login page by going to the new Apply to HMSA link in the footer or on this page below.

Access to HHIN+ is not required to complete the applications.

Registering With HMSA

We encourage providers to participate in all the plans they are eligible for so they can serve as many HMSA members as possible. Completing your application for all of our plans at one time will eliminate the inconvenience of repeating the application and contracting process for other plans. The registration process takes 30 to 60 days after we have received all the required information and documents. Missing information and documents may result in extended processing timelines. Registration includes the HMSA Credentialing Committee’s review of a provider’s credentials, contracting with our networks, and issuing an HMSA Provider ID.

HMSA requires that we credential providers before they join our network. The HMSA Authorization to Release Documents and Information and Dispute Resolution Agreement is required by law and confirms that you are aware that HMSA performs peer, quality assurance, accreditation, and compliance reviews with its participating providers.

Provider Credentialing Requirements

HMSA’s credentialing program is a quality improvement activity that helps ensure that HMSA members receive care from qualified health care providers.

Dental Providers

Applications for dental providers are available at hmsa.com/dental. Or call 808-948-6440 on Oahu or 1-800-792-4672 toll-free on the Neighbor Islands.

HMSA New Provider Application on HHIN+ Guide [PDF]

Provider Enrollment Application (NEW) – Initiate a new provider enrollment application or resume an existing application

Individual Participating Providers

• HMSA New Provider Application (NEW)

Group Application

• HMSA Provider Business Application Form (NEW)

Facility Applications:

• Facility or Long-Term Services & Support Applications (NEW)

Effective 7/1/2025, HMSA will be utilizing ModivCare, our new Non-Emergency Medical Transportation (NEMT) partner who will be managing our NEMT provider network, intake and fulfillment of travel requests. If you are interested in providing NEMT services to HMSA members, please contact Chad Itagaki with ModivCare directly at 808-202-7976 or by email: Chad.Itagaki@Modivcare.com.

Nonparticipating Provider Application

• Provider Enrollment Form – Nonparticipating (NEW)

Nonparticipating Facility Application

• Facility or Long Term Services & Supports (LTSS) Applications – Nonparticipating (NEW)

Supplemental Forms (Practitioners, Groups, Facilities):

• HMSA Authorization and Attestation Form [PDF] – If utilizing this link, the form needs to be downloaded, signed and dated.
• Agent Authorization Form [PDF]
• Facility Programs Attestation & Dispute Resolution Form [PDF]
• Medical Respite Care Provider Attestation Form [PDF] – If utilizing this link, the form needs to be downloaded, signed and dated.
• MR-Organizational-Self-Assessment_2021 [PDF]
• QUEST Integration Additional Contracting Requirements Form [PDF]
• Urgent Care Clinic Attestation Form [PDF] – Needs to be completed if a location is going to be an Urgent Care Clinic.
• W-9 Request for Taxpayer Identification Number and Certification [PDF]
• How to complete the W-9 Form (video)

Revision History