HMSA's credentialing program is a quality improvement activity intended to ensure that HMSA members receive care from qualified health care providers. HMSA verifies the credentials of providers who:
- Seek to participate with HMSA.
- Are listed in HMSA's participating provider directories.
Initial Credentialing Process
Credentialing is initiated by completing a provider application on HMSA’s online provider application HHIN+ (Hawaii Healthcare Information Network). You will be able to access the online application from our HHIN+ login page by using the new Apply to HMSA link in the footer or from the HMSA Provider Resource Center, Apply to HMSA page. Access to HHIN+ is not required to complete the application. Information on the completed application is verified by HMSA's Credentialing Unit. HMSA's Credentialing Committee (which includes practicing participating providers) then reviews applications and other pertinent information to determine compliance with HMSA's credentialing requirements. See HMSA's Professional Credentialing Requirements below for a complete listing of compliance standards.
Providers who meet credentialing requirements will be sent an acceptance letter. Those who do not meet credentialing requirements may appeal the decision by submitting a written notice of appeal and request for binding arbitration. The appeal must be received within 30 days of the date the provider received notification of the Credentialing Committee's denial. HMSA's Legal Services will manage and execute the arbitration process. An appeals process and arbitration are available for adverse recredentialing decisions.
Providers' Right to Review Credentialing File
Providers have the right to review material contained in their credentialing file. The may submit to HMSA's Credentialing Unit, a written request for a copy of their credentialing file. Any material that is peer review-protected or client/attorney protected will not be disclosed. To review the credentialing file, the provider may submit a written request to HMSA's Credentialing Unit at the address below:
HMSA
HSD - Credentialing Unit
P.O. Box 860
Honolulu, HI 96808-0860
Application Status
Upon verbal or written request, HMSA will inform providers of the status of their credentialing application.
When HMSA needs additional information to credential or recredential
A provider is notified of any information obtained during the credentials verification process that differs substantially from the information provided to HMSA by the provider or other sources. A notice is sent to the provider within 10 working days of the discovery or the discrepancy. They are provided 10 working days to respond to the Credentialing Unit in writing to correct any erroneous information.
Correction of information
If a provider believes that HMSA's credentialing file is incorrect or incomplete, they may provide the Credentialing Unit with additional information by writing to the address above.
Recredentialing Process
HMSA requires recredentialing every three years to maintain an updated verification of credentials and to assess provider performance in providing quality, cost-effective health care services. During the recredentialing process, compliance with most professional requirements is re-verified.
In cases in which the provider believes that correct information in their credentialing file may be perceived negatively, the provider may add a statement to the file explaining their view of the circumstance(s) in question.
HMSA Professional Credentialing Requirements for Providers
Click on the links below to view the listed credentialing requirements and descriptions of what constitutes compliance and potential noncompliance for each provider type. Providers who do not meet credentialing requirements will receive additional review by the Credentialing Committee.
*Note: Non-licensed Provider requirements may differ
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |