Updating Your Provider Record

Individual Practitioners must update the following information through our on-line provider self-service tool at Provider Self Service.

• Patient Acceptance
• Close location(s)
• Add location
• Update Location information (contact phone, staff languages, mailing address, etc.)
• Marketing Specialty
• Hospital Affiliations

Group administrators must submit changes in writing for the following provider record updates.

• Termination of your participating status (60 days written notice required)
• A change in your board certification status
• A change in your specialty
• Adding or deleting a location
• A change in group or practice affiliation
• A practice termination
• A change in the direction of your payment
• A change in agent authorization
• A change in your federal tax ID number
• A name change
• A phone number change

These changes to your provider record can be submitted to HMSA using: Address Change, Closed Location, Additional Location Form and Agent Authorization forms.

In addition, participating physicians must notify HMSA in writing of any of the following events:

• Your license to practice in the state of Hawaii is suspended, conditioned, revoked, terminated or subject to terms of probation or other restriction.
• Your federal and/or state drug license is suspended, conditioned, revoked or terminated.
• You become the subject of a disciplinary proceeding or action before the Board of Medical Examiners or similar agency of the federal government.
• You are convicted of fraud or a felony.
• You no longer carry professional or general liability insurance.
• You have been named as a defendant in a malpractice claim or any malpractice judgment or settlement.
• Your business or practice is substantially interrupted by an act of nature or event beyond your reasonable control, and you are no longer able to perform your obligations.

Please send your written notifications to the following address:

Provider Data Administration, KLCR-PDA

HMSA

P.O. Box 860

Honolulu, HI  96808-0860

Email: provider_data@hmsa.com

Fax: 808-948-8210 on Oahu

Revision History