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HMSA Directory - Provider Resources

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HMSA Directory - Provider Resources

 

Appeals Unit

For Private Business:

Phone
  • Oahu - (808) 948-5090
  • Neighbor Islands - 1 (800) 462-2085 toll-free

Fax
  • All islands - 1 (808) 952-7546 on Oahu

Mail
HMSA
Member Advocacy and Appeals
P.O. Box 1958
Honolulu, HI 96805-1958
 

For QUEST Integration appeals:
 
Phone
  • Oahu - (808) 952-7843
  • Neighbor Islands - 1 (800) 440-0640 toll-free

Fax
  • Oahu - 1 (808) 948-8224
  • Neighbor Islands - 1 (800) 960-4672 toll-free

Mail
HMSA QUEST Integration
Member Advocacy and Appeals
P.O. Box 1958
Honolulu, HI 96805-1958

Email: ga_help@hmsa.com 
 

Blue Cross and Blue Shield of Hawaii BlueCard Department

General

Phone
  • Oahu - (808) 948-6280
  • Neighbor Islands - 1 (800) 648-3190 toll-free

Fax
  • Oahu - (808) 948-5947
  • Neighbor Islands - 1 (800) 459-3961 or 1 (800) 459-3962 toll-free

To check eligibility for BlueCard members:

Phone
  • All islands - 1 (800) 676-BLUE (2583) toll-free

Case Management/Care Coordination/Managed Care Services

Program Intake

Phone
  • Oahu - (808) 440-7057
  • Neighbor Islands - 1 (855) 211-4527 toll-free
Available Monday to Friday, 8 a.m. to 5 p.m. After-hours calls are received by a voice mail system and answered the following business day.

Fax
  • For case management: All islands - 1 (808) 948-8248 on Oahu -  Referral Form
  • For care coordination (QUEST Integration only): All islands - 1 (808) 944-5607 on Oahu

Department of Human Services Hotline (for QUEST Integration-related inquiries)

Phone
  • All islands - 1 (808) 692-8099 on Oahu

EDI Support Center

Phone
  • Oahu - (808) 948-6355
  • Neighbor Islands - 1 (800) 377-4672 toll-free

Fax
  • All islands - 1 (808) 948-6008 on Oahu
     

Eligibility (Membership Verification Line)

Phone
  • Oahu - (808) 948-6244
  • Neighbor Islands - 1 (800) 552-8507 toll-free
 
Member ID number required. For instructions, see Membership Verification Line.

 

Federal Employee Program (FEP) of Blue Cross and Blue Shield of Hawaii

General

Phone
  • Oahu - (808) 948-6281
  • Neighbor Islands and Mainland - 1 (800) 966-6198 toll-free

Fax
  • All islands - 1 (808) 948-8222 on Oahu

Mail
HMSA - FEP
P.O. Box 1346
Honolulu, HI 96807-1346



Dental (Effective 7/1/2022):

Phone
Monday - Friday 8 a.m.-4 p.m.
Oahu (808) 948-6281
Toll Free: 1 (800) 966-6198
 
Paper Claims:

HI FEP Claims
P.O. Box 69436
Harrisburg, PA 17106-9436
 


Electronic Claim Submission:
Payor ID: HMSA1 or Speed eClaim process

Resubmission Claims and Correspondence:
HI FEP Claims
P.O. Box 69437
Harrisburg, PA 17106-9437



Retail Pharmacy - Provider Service (for pre-authorization for select prescription drugs):
Phone
  • All islands - 1 (877) 727-3784 toll-free

Retail Pharmacy - Customer Service (for pre-authorization for select prescription drugs):
Phone
  • All islands - 1 (800) 624-5060 toll-free

Hawaii Healthcare Information Network (HHIN+)

For new user registration and setup:
Phone
  • Oahu - (808) 948-6255
  • Neighbor Islands - 1 (800) 603-4672, ext. 6255, toll-free

HHIN+ Help Desk (for technical support):
Phone
  • Oahu - (808) 948-6446
  • Neighbor Islands - 1 (800) 760-4672 toll-free
 

HMSA's Behavioral Health Services –
Commercial, FED 87, HMSA Plan for Postal Service Employees, Medicare Advantage, and Federal Employee Programs (Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB))
(Magellan Hawaiʻi)

For questions regarding:
  • Selecting a behavioral health practitioner for a member.
  • Behavioral health services.
  • Clinical issues relating to patient care.
  • Behavioral health triage.
  • Precertification of benefits.
 
Phone
  • Oahu - (808) 695-7700
  • Neighbor Islands - 1 (855) 856-0578.
Available Monday to Friday 7:45 am to 4:30 pm. After hours on-call assistance available.

Fax
  • All Islands - 1 (808) 695-7799

Mail
Magellan Hawaiʻi
P.O. Box 710490
San Diego, CA  92171

 

For questions regarding Behavioral Health Case Management, see Case Management/Care Coordination/Managed Care Services.

 

Magellan Healthcare, Inc., doing business as Magellan Hawaiʻi, is an independent company providing designated behavioral health services on behalf of HMSA.

 

HMSA's Behavioral Health Services - 
QUEST Integration (Magellan Hawaiʻi)

For questions regarding:
  • Selecting a behavioral health practitioner for a member.
  • Behavioral health services.
  • Clinical issues relating to patient care.
  • Behavioral health triage.
  • Precertification of benefits.

Phone
  • Oahu - (808) 695-7700
  • Neighbor Islands - 1 (855) 856-0578 toll-free
Available Monday to Friday, 7:45 am to 4:30 pm.  After-hours on-call assistance available.

Fax
  • Oahu - (808) 695-7790
  • Neighbor Islands - 1 (855) 539-5880 toll-free

Mail
Magellan Hawaiʻi
P.O. Box 710490
San Diego, CA  92171

 

For questions regarding Behavioral Health Case Management, see Case Management/Care Coordination/Managed Care Services.

 

 

HMSA's Online Care

Phone
  • Oahu - (808) 948-6013
  • Neighbor Islands - 1 (866) 939-6013 toll-free
Available seven days a week, 24 hours a day, except for brief maintenance work scheduled during low-usage periods.

Amwell is an independent company providing hosting and software services for HMSA’s Online Care platform on behalf of HMSA.
 

Operating Engineers Local 3 - Addictions Recovery Program

Phone
  • Oahu - (808) 842-4624
  • Neighbor Islands - 1 (800) 562-3277 toll-free

Fax
  • All islands - 1 (510) 748-7445
     

Pharmacy

Fax
  • All islands - (808) 948-8282 on Oahu

Mail
Sr. Benefit Delivery Specialist
HMSA - Pharmacy Management
P.O. Box 860
Honolulu, HI 96808-0860
 

Precertification Unit

General

Phone
  • Oahu - (808) 948-6464
  • Neighbor Islands - 1 (800) 344-6122 toll-free
  • Mainland - 1 (800) 877-5394 toll-free
Available Monday to Friday, 8 a.m. to 4 p.m. Hawaii Standard Time. After-hours calls are received by a voice mail system and answered the following business day.

Fax
  • All islands - 1 (808) 944-5611 on Oahu

For questions about the utilization management process:

Mail
HMSA - Medical Management Department
P.O. Box 2001
Honolulu, HI 96805-2001
 

Privacy Office

Mail
HMSA - Privacy Office
Privacy Official, 8th Floor
P.O. Box 860
Honolulu, HI 96808-0860
 

Provider Correspondence

Phone
  • Oahu - (808) 948-6330
  • Neighbor Islands - 1 (800) 790-4672 toll-free

Fax
  • Oahu - (808) 948-8201
  • Neighbor Islands - 1 (877) 439-8201
 
Mail
HMSA - Provider Operations
ATTN: Research and Correspondence
P.O. Box 860
Honolulu, HI 96808-0860

Provider Data Administration

For registration, provider number assignment, questions regarding eligible fees, and address changes.

Phone
  • Oahu - (808) 952-7847
  • Neighbor Islands - 1 (800) 603-4672 ext. 7847 toll-free

Mail
HMSA
Provider Data Administration
P.O. Box 860
Honolulu, HI 96808-0860

Provider Services (Automated Answering System)

Phone
  • Oahu - (808) 948-6330
  • Neighbor Islands - 1 (800) 790-4672 toll-free

Fax
  • Oahu - (808) 948-6887
  • Neighbor Islands - 1 (800) 540-1668 toll-free
     

Provider Services for The HMSA Plan for QUEST Integration Members

General

Phone
  • Oahu - (808) 948-6486
  • Neighbor Islands - 1 (800) 440-0640 toll-free
Available seven days a week, 24 hours a day.
 

Mail
HMSA - QUEST Integration Operations
P.O. Box 3520
Honolulu, HI 96811-3520


Benefit precertification for managed care program services:
Fax
  • All islands - (808) 944-5611 on Oahu

For providers or members who need immediate assistance after hours for urgent or emergent cases requiring transportation arrangements, eligibility verification, or help finding a participating provider:

Phone
  • All islands - 1 (855) 874-8511 toll-free.  
  • Available seven days a week, 4:30 p.m. to 7:45 a.m.


Can't find what you are looking for or have general PRC questions? email us at PRC@hmsa.com

 

HMSA Akamai Advantage® is a PPO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage depends on contract renewal.

Rev#:Date:Nature of Revision:
3.7 (v26)12/31/20241100-956557-1207858 Updated references and information from Carelon Behavioral Health to Magellan Hawaiʿi.
3.6 (v25)12/18/20241100-956557-1199850 Section header and link updated to include FEHB and PSHB for FEP and HMSA Plan for Postal Service Employees.
3.5 (v24)03/01/2024Removed fax numbers from the Provider Services for The HMSA Plan for QUEST Integration Members - General section.
3.4 (v23)02/27/2024Minor formatting edits.
3.3 (v22)02/05/2024The following disclosure statement has been added: 
HMSA Akamai Advantage® is a PPO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage depends on contract renewal.
3.2 (v21)01/26/2024Update number from 1 (800) 820-7248 to 1 (855) 874-8511.
3.1 (v20)01/25/2024Service mark added to the first text reference of Carelon Behavioral Health.
The following disclosure statement has been added: 
Carelon Behavioral HealthSM is an independent company providing behavioral health utilization management and quality improvement services on behalf of HMSA.
3.0 (v19)01/23/2024Registration mark added to HMSA's Online Care
The following disclosure statement has been added: 
Amwell is an independent company providing hosting and software services for HMSA’s Online Care platform on behalf of HMSA.
2.7 (v18)06/12/2023Updated three references of HHIN to HHIN+.
2.6 (v17)04/10/2023Updated the contact information for FEP dental claims.
2.5 (v16)04/03/2023Update Appeals contact information for QUEST Integration.
2.4 (v15)02/24/2023Updated all references from Beacon Health Options to Carelon Behavioral Health. 
Includes update to mailing address.
2.3 (v14)01/25/2023Removed references for HMSA's Disease Management Services.
2.2 (v13)07/15/2022Updated mailing title for Provider Correspondence to HMSA-Provider Operations.
2.1 (v12)06/27/2022Updated the fax number under the Federal Employee Program (FEP) of Blue Cross and Blue Shield of Hawaii section.
2.0 (v11)06/23/2022Added dental contact information under the Federal Employee Program (FEP) of Blue Cross and Blue Shield of Hawaii section. Effective 7/1/2022.

 

Rev#:Date:Nature of Change:
1.006/30/2006New version consolidates, expands and restructures previously published telephone directories.
1.107/21/2006Added Provider Services Field Staff entry and changed title of Provider Information Unit entry. Made minor formatting and character spacing changes.
1.211/07/2006Changed Oahu HHIN phone number to new number.
1.312/28/2006Updated Automated Answering System section under Providers-General.
1.404/12/2007Changed Provider Information Unit toll-free number. Corrected revision number 1.3.
1.511/15/2007Changed the Oahu Provider Information Unit telephone number.
1.602/04/2009Revised Customer Service phone tree list to reflect current version of phone menu.
1.709/03/2009Automated Answering System instructions were updated with changes effective May 1, 2009. Second bullet that says to press 2 for Provider Services changed to say press 2 for Health Care Professional. Section that says to press 5 for medical plan benefit and claims questions, added a fourth bullet that reads Press 4 for All Others. 
1.801/14/2011Removed bullet from BCC section regarding patient registration
1.907/18/2011Revised named for Healthways capabilities and made other minor changes.
1.1010/04/2011Consolidated and updated all contact information for HMSA. The previous "HMSA Telephone Directory", "HMSA Fax Directory" and "HMSA Mailing Address Directory" has been consolidated into this new page, which is now called the "HMSA Directory". 
1.1111/14/2011Added contact information for Claims, Pharmacy and made other minor grammatical fixes.
1.1208/28/2012Updated the Pharmacy phone number from 808-529-8964 to 808-533-1482.
1.1312/31/2012Replaced the Medco content with CVS Caremark content.
1.1401/07/2013Added a new section and contact information for "HMSA's Behavioral Health Services - Commercial, FEP, FED 87 (Beacon Health Strategies)"
1.1510/08/2013Updated the contact information for Beacon Health Strategies.
1.1603/17/2014Added the new email for provider appeals.
1.1701/21/2016Updated fax number in the HMSA's Disease Management Services section.
1.1806/10/2016Updated the mailing information for the Provider Data Administration & Provider Correspondence.
1.1902/10/2017Removed (2) 65C Plus references and changed the toll-free number for the Medicare Program from 1 (800) 776-4672 to 1 (800) 660-4672.
1.2003/14/2017Updated the Provider Data and Contract Administration on Oahu and NI phone numbers.
1.2103/17/2017Updated the Provider Data and Contract Administration to Provider Data Administration.
1.2204/24/2017Updated to "Beacon Health Options."
1.2308/07/2017Under HHIN ETS Outreach, change phone # from "5851" to "6275":
1.2408/07/2017Under HHIN ETS Outreach, change phone # from "6275" to "6255":
1.2508/16/2017Added back Appeals Unit contact information.
1.2609/13/2017Added QUEST Integration Claims address information to the Claims section.
1.2712/11/2017Changed "Medicare Program (Akamai Advantage) Members" to "Medicare Advantage Members​".
1.2803/26/2018Updated title to HMSA's Behavioral Health; includes content update (address). Removed outdated webinars: Coreo Learning Series & Risk Adjustment - The Importance of Coding Specificity and Documentation
1.2904/17/2018The Pharmacy fax number was updated.
1.3010/31/2018Updated the Dental Provider Services Field Representatives contact information.
1.3106/01/2020Updated Membership Connection to Membership Verification Line. Reformatted page.
1.3208/31/2020Updated Time and Fax # for Case Management/Care Coordination/Managed Care Services. Added link to the referral form.
1.3303/23/2021Updated the Provider Data Administration contact information.
1.3406/23/2021The current source documents have been moved to a new document repository and links have been updated. HMSA_Provider _Referral Form.
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HMSA-Directory-Provider-Services

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