Medical
Genetic Testing Management (GTM) Utilization Review Matrix REVISED Effective March 1, 2025
Learn about the Genetic Testing Management (GTM) Utilization Review Matrix, including review criteria, coverage requirements, and authorization guidelines for genetic testing.
Health Maintenance Organization Administrative Review
Guidelines for HMO administrative review, including requirements, processes, and criteria for reviewing services and payment decisions.
Health Maintenance Organization Precertification Requirements
Learn HMSA HMO precertification requirements, including services that need prior approval, referral guidelines, and how to submit requests with required documentation.
HMSA Medical Policies, Formularies, and Related Information
Overview of HMSA medical policies, drug formularies, and related provider information, including coverage guidelines, clinical requirements, and claims resources.
HMSA’s Business Association with NIA
Overview of HMSA’s business association with National Imaging Associates (NIA), including imaging service management and precertification responsibilities.
HPH/HMO Travel Registry Form
Guidelines for HPH/HMO travel registry requests, including interisland travel coverage, eligibility, and submission requirements for approval.
Incisions – Complicated
Guidelines for coding complicated incisions, including CPT criteria, definitions of complexity, and documentation requirements.
Initial Preventive Physical Exam
Guidelines for the Initial Preventive Physical Exam, including eligibility, covered services, and billing requirements.
Intravenous Immune Globulin (IVIG) Therapy – Administrative Information – IV Therapy Index
Guidelines for IVIG therapy administrative information, including billing codes, payment criteria, and claims submission requirements.