High Dollar Claims Reviews by Equian, LLC

Equian, LLC (Equian) has been retained by HMSA to review select high dollar claims.

Equian’s review process applies condition specific medical and financial expertise to review itemized bills for potential errors, variances from billing requirements, and charges for supplies or services that HMSA otherwise excludes from reimbursement.

Claims meeting the following criteria will be reviewed

• BlueCard Host, Commercial (Private Business), Medicare and QUEST Integration Member Claims
• Inpatient Acute Level Claims
• Allowed amount (eligible charge) is:
  • $200,000 or more for Commercial (Private Business) and Medicare
  • $100,000 or more for BlueCard Host and QUEST Integration
• Any pricing method other than: base DRG, case rate, or per diem
• In-network, Hawaii providers

If a claim meets these criteria, HMSA will request an itemized bill, Equian will review the claim and the itemized bill, and a report will be sent listing any adjustments. Equian and HMSA will be available to answer questions.

For more information, please contact:

Equian

Phone: 1-800-806-9784

Email: claimsresolution@equian.com

Standard/USPS mail:

Equian – IBR

PO Box 1090

Draper, UT  84020-1090

UPS/FedEx packages:

Equian – IBR

12921 S. Vista Station Blvd.

Draper, UT  84020

HMSA’s Customer Service

BlueCard

Phone: 808-948-6280 on Oahu or toll free at 1-800-648-3190

Commercial and Medicare

Phone: 808-948-6330 on Oahu or toll free at 1-800-790-4672

QUEST Integration

Phone: 808-948-6486 on Oahu or toll free at 1-800-440-0640

Revision History