HI HMSA Precertification Request Form 2015 free printable template

HSA RECERTIFICATION REQUEST Please fax completed form to: (808) Or Mail to: Phone Nos: Recertification Request* Review of Service(s) Not Requiring Recertification 9445611 HSA Medical Management Department

How to fill out HI HMSA Precertification Request Form

How to fill out HI HMSA Precertification Request Form

1. Obtain the HI HMSA Precertification Request Form from the HMSA website or your healthcare provider.
2. Fill in patient information, including full name, date of birth, and insurance identification number.
3. Provide details about the requested service, including procedure name, date of service, and place of service.
4. Include the physician's details, such as name, contact information, and provider identification number.
5. Detail the medical necessity for the requested service, including relevant diagnoses and supporting medical documentation.
6. Review the completed form for accuracy and completeness.
7. Submit the form via fax, mail, or through the HMSA online portal as instructed.

Who needs HI HMSA Precertification Request Form?

1. Patients requiring prior authorization for medical procedures, treatments, or services covered under their HI HMSA insurance plan.
2. Healthcare providers submitting requests for their patients for services that may require precertification.

People Also Ask about

Is HMSA a Medicare?

Plan Description HMSA Akamai Advantage® is a Medicare Advantage plan to help members live well. It has all the benefits of Original Medicare and much more to help them be at their best health and well-being.

How do I file a claim with HMSA?

If you have a complicated claim question or concern, you can call HMSA's Customer Relations at (808)948-6330 on Oahu or 1(800)790-4672 toll-free on the Neighbor Islands.

What is the phone number for HMSA provider in Hawaii?

How do I Change my Primary Care Provider? If you need to change your HMO primary care provider (PCP), call HMSA Customer Relations at 808-948-6372 on Oahu or 1-800-776-4672 toll-free.

Is HMSA considered Medicare?

With HMSA Medicare Advantage, you can get an all-in-one plan with medical, prescription drug, dental and vision, and extra benefits beyond Original Medicare .

How do I make a claim with HMSA?

If you have a complicated claim question or concern, you can call HMSA's Customer Relations at (808)948-6330 on Oahu or 1(800)790-4672 toll-free on the Neighbor Islands.

What is HMSA timely filing limit?

Military facility claims must be submitted to HMSA within 6 years of the date of service. Participating Medicare Advantage providers have one year from the date of service to file all claims (e.g.; initial submissions, resubmissions, adjusted submissions) to HMSA.

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What is HI HMSA Precertification Request Form?

The HI HMSA Precertification Request Form is a document used to obtain prior authorization from Hawaii Medical Service Association (HMSA) for certain healthcare services to ensure that they are medically necessary.

Who is required to file HI HMSA Precertification Request Form?

Healthcare providers or facilities requesting coverage for specific procedures, treatments, or services on behalf of their patients are required to file the HI HMSA Precertification Request Form.

How to fill out HI HMSA Precertification Request Form?

To fill out the HI HMSA Precertification Request Form, provide patient information, details about the requested service, medical necessity justification, relevant codes, and physician signatures as required.

What is the purpose of HI HMSA Precertification Request Form?

The purpose of the HI HMSA Precertification Request Form is to ensure that proposed medical services or procedures meet HMSA's coverage criteria and to authorize payment before the services are rendered.

What information must be reported on HI HMSA Precertification Request Form?

The information that must be reported on the HI HMSA Precertification Request Form includes patient demographics, insurance details, service codes, descriptions of the requested services, and clinical documentation supporting the medical necessity.