Eligibility - Behavioral Health

You may confirm a member's eligibility by checking his or her current HMSA  member ID card.

HMSA Non-QUEST Members

The card provides you with several pieces of essential information including:

• The HMSA member ID number
• The coverage code

This information should be adequate, in most cases, for you to file claims.  However, there may be occasions when you wish to double-check eligibility for a specific patient.  For example, you may wish to verify whether the subscriber's spouse or child is covered by the plan.

A simple way to verify eligibility for a non-QUEST patient is to use your touch-tone phone to access HMSA's membership records through Membership Verification Line.

The HMSA Plan for QUEST Members

A member's QUEST card will provide the following information:

• QUEST member number
• Name of Primary Care Physician and effective date of assignment
• Type of coverage (i.e., QUEST, QUEST-Net)
• Other insurance that may be available

This information should be adequate, in most cases, for you to file claims.  However, there may be occasions when you wish to double-check eligibility for a specific patient.  For example, you may wish to verify whether the subscriber's spouse or child is covered by the plan.

To verify eligibility for a QUEST patient, call the QUEST eligibility line at 808-948-6486 on Oahu or 1-800-440-0640 from the Neighbor Islands.

After-Hours Assistance for The HMSA Plan for QUEST Members:

Providers needing immediate assistance after hours for urgent or emergent cases requiring transportation arrangements, eligibility verification or assistance in locating a participating provider can call 1-855-874-8511.  This number is available Monday through Friday, 4 p.m. to 8 a.m. and on weekends and holidays.

All HMSA Members

In addition, if you subscribe to the Hawaii Healthcare Information Network (HHIN), you may access this information electronically for all HMSA patients. See HHIN+ Documents & Information.

Verifying Eligibility

HMSA will assist in providing you with accurate eligibility information.  However, the member is responsible for advising you of correct eligibility information.  We remind you that any eligibility information our representatives give you is accurate on the date it is given, but may be subject to change and does not guarantee payment.

Employer groups are responsible for giving HMSA updated employee membership information on a monthly basis.  Information is subject to change if updates are submitted late, or if an employer wishes to cancel an employee's coverage retroactively to the date he or she left employment.

General eligibility verification can be done through Membership Verification Line and HHIN Documents & Information.

Because annual benefits for behavioral health services are limited, you may wish to contact an HMSA Provider Teleservice Representative before rendering services to verify the member's benefits.  On request, the representative will provide you with an estimate of the number of annual visits remaining, based on claims submitted with HMSA prior to the date of your inquiry.

Revision History