Home Health Care Services

Home health care refers to intermittent skilled health care related services provided by a licensed home health agency to an individual in his or her place of residence. Skilled health care related services include skilled nursing care and physical, occupational, and speech therapies.

For QUEST Integration, precertification is required for treatment. However, for initial requests, the evaluation for respective skilled disciplines (e.g., physical or occupational therapy, skilled nursing) ordered by a physician does not require an authorization.

A registration for your home health evaluation visits must still be completed with HMSA to ensure compliance with the State of Hawaii’s Medicaid requirement for electronic visit verification (EVV) program. As such, you may register your evaluation visits through our online precertification portal via HHIN+. Here is a link to the iExchange YouTube training video and you may email (iExchange@hmsa.com) or call (808-948-6464) if you need additional assistance or training.

Please follow the guidelines below for your evaluation submissions:

1. The following codes and modifier can be submitted for an evaluation:
   1. G0299-U6 (registered nursing)
   2. G0300-U6 (licensed practical nursing)
   3. G0151-U6 (physical therapy)
   4. G0152-U6 (occupational therapy)
   5. G0153-U6 (speech therapy)
   6. S5180-U6 (respiratory)
2. Units for a specific discipline should not exceed 1 unit.
3. Enter the date range in which you anticipate the evaluation to be completed. However, the evaluation for respective disciplines is not limited to the same date.
4. Treatment Setting should always reflect “Home”
5. Servicing Provider should reflect your HMSA provider 10-digit ID that is associated with your ‘home health agency’ specialty classification. If you use an ID that is associated with another specialty, your request will PEND for a review.

If you apply the guidelines above, you should receive an immediate outcome upon submission to include an authorization ID. You can also print the confirmation page for your record.

You may refer to HMSA’s Home Health Care – QUEST Intgration medical policy on the provider resource center for additional guidelines. Complete HMSA’s Home Health Assessment Precertification Form [PDF] provide the information listed below:

1. Plan of Care signed by the treating physician that includes the frequency, duration, and type of home health services (e.g. part-time skilled nursing services, physical, occupational and/or speech therapy); and
2. Medical records supporting medical policy criteria

Mail:

Precertification

HMSA Medical Management Department

P.O. Box 2001

Honolulu, Hawaii  96805

Fax: 808-944-5611

For our commercial (PPO, HMO) plans, precertification is not required. However, services that exceed the following limits may be subject to medical necessity review:

1. Services provided more than one time per day, per discipline.
2. Services provided more than three times per week, per discipline.
3. Services provided daily, for more than two weeks; or
4. Services exceeding 30 days.

For our Medicare Advantage plan, precertification is not required. However, notification of admission to home health services must be submitted to HMSA by fax at: 808-944-5611.

Revision History