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:

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 (https://provider.hmsa.com/selfservice) 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

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

Please Complete your Enrollment with MQD

The state Medicaid Agency, Department of Human Services Med-QUEST Division (MQD), is now required by Federal Law to perform more-comprehensive screening, credentialing, and enrollment for Hawaii Medicaid providers. To remain eligible for Medicaid reimbursement, providers must complete and submit to MQD the Medicaid Provider Application/Change Request Form (DHS 1139) once every five years. Even providers who have an active HMSA QUEST Integration contract may have their future payments suspended or denied if they don’t submit the DHS 1139 form to MQD. The latest status report from MQD dated August 10, 2018, shows they don’t have a current DHS 1139 from you. We encourage you to join the 70 percent of HMSA’s network providers who have submitted the form to MQD. Download the form and instructions from the MQD website, medquest.hawaii.gov/en/plans-providers/fee-for-service.html. Submitting one enrollment form to MQD covers all QUEST Integration health plans. If you have questions for MQD, call 692-8099 on Oahu or email hcsbinquiries@dhs.hawaii.gov. Due to high call volumes, the staff may not respond immediately. In that case, we recommend that you make your best efforts to complete the application and mail it to: Med-QUEST Division Health Care Services Branch Provider Enrollment 601 Kamokila Blvd., Room 506A Kapolei, HI 96707 When they receive your application, MQD will contact you if there are any issues to address. Please call HMSA QUEST Integration Provider Services 948-6486 on Oahu or 1 (800) 440-0640 toll-free on the Neighbor Islands if you have questions. Thank you for your continued support of HMSA QUEST Integration. Sincerely, Andreas K. Cravalho II Executive Director Medicaid Programs 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
  • Introducing the New Self-Service Tool

  • Medical Record Requests from Inovalon

  • Enrollment with MQD

  • 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

Programs16

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

Training21

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

FAQ's23

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

Tools26

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

Forms31

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

News37

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.