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Hawaii Medicaid Fiscal Agent
1132 Bishop Street, Ste. 800
Honolulu, HI 96813
1. Date of Inquiry2. Provider Name (Last, First, Middle Initial)3. Provider Number4. Address:5. Telephone Number6. Name
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Who needs providers may use this?
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Providers may use this to ensure that their information is accurately represented and easily accessible to others.
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Healthcare organizations or institutions may also require providers to fill out these forms for credentialing or enrollment purposes.
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What is providers may use this?
Providers who offer services or products that are eligible for reimbursement by insurance companies or government programs may use this.
Who is required to file providers may use this?
All providers who wish to receive reimbursement for their services or products must file providers may use this.
How to fill out providers may use this?
Providers can fill out providers may use this by providing detailed information about the services or products provided, as well as the cost and any relevant medical codes.
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The purpose of providers may use this is to ensure that providers are accurately reimbursed for the services or products they provide.
What information must be reported on providers may use this?
Providers must report information such as the patient's name, date of service, type of service provided, and cost.
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