Please contact Provider Correspondence for membership eligibility and general benefit information. You also may access benefit information online using the Hawaii Healthcare Information Network (HHIN+).
Benefits for a number of procedures, therapies, and surgeries must be precertified before payment can be made.
To prevent misunderstandings, if you are considering purchasing new equipment or performing a surgery, therapy, or procedure that employs new technology, uses a new application of existing technology, or is investigational in nature, please contact us in advance for a determination of whether the service will be covered.
Please fax or mail your written request to the Precertification Unit.
Please help us to process your request in a timely manner by including the following information in your request:
- The patient's name and HMSA member ID number.
- Diagnosis (ICD-9-CM/ICD-10-CM).
- Details regarding the history of the illness and other therapies attempted.
- The CPT code and description for the procedure, therapy or surgery you are proposing.
- Your rationale for proposing the service.
- Any supporting information you may have regarding the necessity for and effectiveness of the service.
We will respond within 10 working days with a determination of whether the proposed service is eligible for benefits under the member's plan or if additional information is needed to further evaluate the service.
Claims Filing Information
If the service in question is precertified for benefits, please enter the HMSA precertification number in Block 23 of the CMS 1500 claim form.
