QUEST Integration - Private Duty Nursing

Original Effective Date:

08/01/1994

Current Effective Date:

01/01/2015

Private duty nursing is not covered under QUEST Integration.

Exception: A child may receive private duty nursing under the EPSDT program, which covers needed medical care that normally is not a benefit of QUEST Integration. Services must be precertified and are subject to the following guidelines:

• Services are rendered by a duly licensed registered nurse (R.N.) or licensed practical nurse (L.P.N.)
• Services are directed by the attending physician
• Services are consistent with the diagnosis and treatment of an illness or injury

Precertification Requirements

Requests must be submitted in writing by mailing or faxing the request to:

Precertification Unit – 6th Floor

HMSA – Medical Management Department

P.O. Box 2001

Honolulu, HI  96805

Fax: 808-944-5611

Exclusions

• If the skills of an R.N. or L.P.N. are not essential or normally would be provided to an inpatient by the hospital or skilled nursing facility, no payment will be made for such services.
• Services rendered by a family member are not payable.

Revision History