QUEST Integration – Eligibility – Membership Cards

Original Effective Date:

01/01/1994

Current Effective Date:

01/01/2015

Membership cards are issued to each individual covered under QUEST Integration. We recommend that you check a patient’s QUEST Integration card at each visit for possible changes in their insurance information. Cards are re-issued as necessary following the Plan Change Period or when there is a change in PCP, eligibility, or other insurance information.

The card provides the following valuable information useful in filing claims and determining benefits:

• Member Name
• Member ID – consists of ten numeric digits including leading zero(s). This number must be entered on claims exactly as it appears on the card, without the XLQ or XLN alpha prefix, which is only relevant for providers who render services outside the state of Hawaii. Entering an erroneous member number will delay claims processing and may result in unnecessary denied claims.
• Birth Date – confirm this date with your records as claims with birth date discrepancies may cause processing delays
• Sex
• PCP – the provider responsible for coordinating the patient’s medical care
• Network – The PCP’s network.
• PCP Phone – The PCP’s telephone number.
• PCP Effective Date – the effective date of the member’s assignment to the PCP.
• Effective Date – The effective date will display when the patient’s coverage began.
• Benefit – indicates whether the patient is QUEST Integration-Adult or QUEST Integration-Keiki.
• RXBIN – For pharmacy use only.
• RXPCN – For pharmacy use only.
• RXGRP – For pharmacy use only.
• TPL – The TPL field will display “YES” or “NO” to indicate whether the patient has any other coverage in addition to QUEST.

Additional Terms and What They Mean

“EPSDT” – (in the lower right quadrant of the front of the card) identifies an individual who is eligible to receive EPSDT benefits. (See QUEST Integration – Early Periodic Screening, Diagnostic and Treatment (EPSDT).

Please click the link below to view the current QUEST Integration card samples:

Current QUEST Integration Card Samples [PDF]

Revision History