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:

Medical Record Requests from Inovalon

In the next month or so, a company called Inovalon may call your office to request medical records on behalf of a Mainland-based member organization of the Blue Cross Blue Shield Association (BCBSA). The BCBSA contracts Inovalon to coordinate the transfer of medical records between BCBS insurers. The most likely reason for the request is the annual Risk Adjustment Data Validation audit of the Affordable Care Act (ACA; commercial) population. If Inovalon contacts you, please comply with their request in a timely manner. The medical records will be used to substantiate data submitted to the U.S. Department of Health and Human Services for the ACA risk adjustment program. Your support of risk adjustment helps insurers maintain the financial resources needed for medical claim reimbursement. read more...1

Temporary Suspension of Certain Home Health, Hospice, and Skilled Nursing Facility Claims

The Centers for Medicare & Medicaid Services (CMS) is alerting all Coordination of Benefits Agreement (COBA) trading partners to the following: Medicare Part A shared system has been alerted to a problem involving Home Health, Hospice, and Skilled Nursing Facility Claims (SNF) when the provider submits a Medicare Beneficiary Identifier (MBI) on incoming claims. Specifically, currently, when the criteria below are met, the Part A system attempts to process the claims using an inactive Health Insurance Claim Number (HICN). This identified issue is causing the aforementioned claims to be Returned to the Provider (RTP). read more...1

Coreo is set to launch May 1, 2018

Coreo is set to launch on May 1, 2018. This is the first version of Coreo that we’re releasing and more features will be rolled out in the coming weeks and months. 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: • QUEST Integration Webinar • CMS 1500 Basic Claims Filing Webinar • Coreo Learning Series. • Past and present training videos and materials. read more...1

Provider Directory Update Reminder

Accurate information on your practice is critical to our members who rely on our directories. They need up-to-date information to make it easier to contact providers in our network. Also, the Centers for Medicare & Medicaid Services (CMS) requires us to have current information. read more...1

Termination Notification: Cozeva Patient Attestation Form

Starting May 1, you’ll no longer be able to use Cozeva to manage your patient panel, such as adding or removing patients. read more...1
  • Medical Record Requests from Inovalon

  • Temporary Suspension of Certain Claims

  • Coreo Launch!

  • HMSA's Provider Training

  • Provider Directory Update

  • Cozeva Patient Attestation Form

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.