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:

Reminder: Professional and Vocational License Expire on December 31, 2018

This request is especially important for Physical Therapists, Occupational Therapists, and Marriage & Family Therapist whose licenses expire on December 31, 2018. Please take a moment to check the expiration date on your professional state license. We encourage you to renew your license as soon as possible since it may take time to complete the process. We’ve been advised that there’s a time lag between renewing a license and posting the renewal on the state’s licensing website, which we reference for current licensure verification. read more...1

Annual Provider Survey for Payment Transformation Providers

Thank you for your participation in HMSA's Payment Transformation Program. The Payment Transformation Annual Provider Survey allows HMSA to collect valuable feedback from PCPs about the Payment Transformation program and your Physician Organization (PO). Completion of the survey is part of each PO's Performance Measure set. After the survey closes, HMSA will share a report with PO leaders that contains aggregated, de-identified responses. Each PO will receive a report on its own PCPs only. Directions: Please answer all questions completely and thoroughly. Do not include patient-identifying information such as names, birthdates, addresses, etc. read more...1

Provider Self-Service Tool

We are excited to announce that in early October, HMSA will be launching a new on-line provider self-service tool ( to ensure that we have the most current and up-to- date information available for our members. Provider self-service will enable our provider community to directly submit requests online to update their demographic information with HMSA. Providers will have the opportunity to update the following administrative data: - Patient Acceptance - Close location(s) - Add location - Update Location information (contact phone, staff languages, mailing address, etc.) - Marketing Specialty - Hospital Affiliations The initial release will enable functionality for individual practitioners and in the near future, the same service will be available for providers who practice within a group. We will be expanding provider self-service options in the coming months to include additional features and will keep you posted. 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
  • State License Renewal

  • Payment Transformation Annual Provider Survey

  • Introducing the New Self-Service Tool

  • HMSA's Provider Training

  • Provider Directory Update

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 and Federally Qualified Health Centers and Rural Health Centers18. Visit Medicare Star Ratings19 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.