Provider Portal - At Your Fingertips

HMSA is pleased to offer this comprehensive, frequently updated online reference for healthcare providers who serve HMSA members. We encourage you to familiarize yourself with the Provider Resource Center's sections, particularly the following:

HealthPro News February 2018 Edition

What’s inside: • Contract Notification • Coding Claims • Pharmacy • Policy News • and much more… read more...1

Reminder: Medicaid Provider Enrollment – DHS 1139

To remain eligible for Medicaid reimbursement, providers must complete and submit to MQD the Medicaid Provider Application/Change Request Form, also called the DHS 1139, once every five years. read more...1

HMSA's Provider Training - Upcoming Webinar Schedule

We’re here to assist you and your staff in servicing our members—your patients. HMSA appreciates the quality service you provide to our members and look forward to continuing our mutually beneficial relationship with you and your staff. Here you will find: • New Provider Orientations. • Payment Transformation: 2018 Measure Changes and Updates • Quest Integration Basics. • HMSA Akamai Advantage Dual Care. • Coreo Learning Series. • Past and present training videos and materials. read more...1

HealthPro News January 2018 Edition

HealthPro News January 2018 Edition HMSA’s monthly publication for participating HMSA health care providers, facilities, and their staff. What’s inside: • Contract Notification • Coding Claims • Pharmacy • Policy News • and much more… read more...1

2018 HMSA Payment Transformation Program Guide

The 2018 Payment Transformation Program Guide includes information for PCPs and POs. The PT program replaced HMSA’s payments that were based on existing fee schedules, pay-for-quality (P4Q) programs, and patient-centered medical home (PCMH) programs. Log in to HHIN to see the 2018 Payment Transformation Program Guide read more...1
  • HealthPro News February 2018 Edition

  • Reminder: Medicaid Provider Enrollment

  • HMSA's Provider Training: January & February 2018

  • HealthPro News January 2018 Edition

  • 2018 HMSA Payment Transformation Program Guide

Reference Information6

Provider Library7

Contains HMSA’s medical policies8, formulary9 information, claims filing10 guidelines, payment and appeals11 processes, behavioral health12 policies, and other important information

Plan Libraries13

View specific policies and processes associated with our QUEST Integrated14 (Medicaid) and Akamai15 (Medicare) programs


Learn about incentive programs offered by HMSA, such as Payment Transformation17, Pay for Quality18, & PCMH19 Visit Medicare Star Ratings20 for Stars-related measure reference guides and other tools


View webinars and materials on Payment Transformation, Pay for Quality, ICD-10, QUEST Integration, Akamai Advantage, and other topics

Out of Area Policies22

Look up medical policies and pre-certification / pre-authorization information for out-of-area members


View providers’ questions regarding provider support, claims, medical policies, pre-certification, appeals, contracting, radiology management, and other topics.

Contact Us24

Helps you find contact information for the various departments at HMSA that are here to serve you.

Tools & Forms25


Access online tools such as Cozeva27, HHIN28 (or HHIN’s documentation29), and HMSA’s Online Care30


Download, complete, and return forms for servicing commercial32, QUEST Integrated33, and Akamai members15. Forms on behavioral health34 care are also available.

Useful Websites35

A list of websites which we think may be helpful to you, such as State and Federal agencies, coding references, etc.

News & Letters36


Read about recent news that impacts providers, or view the archive of previous news that may still apply

Communication Archive38

Review HMSA communications to providers via HealthPro News and other channels

Join Our Network39

Learn About HMSA40

Learn about HMSA’s mission, our history, the plans we offer, and how to apply to join our network.

Join HMSA41

Begin the process of joining HMSA’s provider network.