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Nonparticipating Provider Enrollment and Billing Guidelines

Registration and Enrollment

We transitioned our hard copy non-participating provider application to an online form on our provider portal, HHIN+. Once the enrollment form is completed and received, the registration process may take 90 to 120 days after receiving all required and completed documents. You may experience delays when your forms or required documents are incomplete. HMSA will contact you to obtain the missing information/documentation, but if we don’t receive the information and required documents after several follow-up attempts, we will close your request and you’ll need to re-submit the enrollment form and documents to restart the process.

HMSA will send you a confirmation letter with your HMSA nonparticipating provider ID number which will be used to process your claims.

If you have any questions regarding enrollment or the application, please contact Provider Services 808-948-6330 or 1-800-790-4672.

Claims and Billing Information

Nonparticipating Providers may file claims on behalf of the member.

For information about completing your claim forms, refer to the links below:

Important Note:

The National Uniform Claim Committee (NUCC) is responsible for designing and maintaining the CMS-1500 form. HMSA does not supply the form to providers for claim submission. To purchase claim forms, you should contact the U.S. Government Printing Office at 1-866-512-1800, local printing companies in your area, and/or office supply stores. Each of the vendors above sells the CMS-1500 claim form in its various configurations (single part, multi-part, continuous feed, laser, etc.). (U.S. Centers for Medicare & Medicaid Services, 2016)

How to file claims to HMSA

  • Electronic Transaction
    • HMSA offers several electronic transactions that are electronic data interchange (EDI) compliant. EDI is an electronic communication method that provides standard formats for sending electronic claims.
    • For more information and to learn how to get started, refer to the online EDI HELP GUIDE [PDF] , or you can call the ETS Outreach team at 808-948-6255 on Oahu or 1-800-603-4672, ext. 6255 toll-free on the Neighbor Islands.
  • Hard-copy Paper Claims
    • You can also submit a paper claim for reimbursement and send it to HMSA at the appropriate mailing address.
    • HMSA’s claims scanner allows us to automatically enter clearly presented information from your claims into our claims processing system. When we utilize this equipment, we can process your requests promptly and avoid data processing errors. Claims that cannot be scanned must be manually entered into the claims processing system.
    • You can facilitate the timely, accurate processing of your claims by:
      • Typing or computer printing your claim.
      • Using black or dark blue ink. Do not use red ink. Red ink is not preserved in the scanning process.
      • Using an Arial or Times New Roman font with a font size of 8-10 that is bolded.
      • Not obscuring any information with a highlighter.

Note:

Claims must be received within a year from the last day on which services were received. For HMSA’s Plan for Federal and Postal Employees, claims will be accepted until December 31 of the year after the year service was received. Refer to the Federal and Postal plan brochure for more information – Timeliness Standards.

Precertification

Nonparticipating providers are NOT required to submit a pre-certification. However, you may choose to request on behalf of the member.

Pre-certification form request is accessible on the Forms Index Provider E-Library page and QUEST Integration – Forms Index Provider E-Library page (some services have a specific form available which may be located on the General Pre-Certification Form [PDF] Provider E-Library page).

Pre-certification requests to HMSA’s MM department can be sent via the following:

  • Mailing address

    HMSA

    MM Department

    P.O. Box 2001

    Honolulu, HI  96805-2001

  • Fax number

    808-944-5611

    Attn: Medical Management Department

Related Information

References

U.S. Centers for Medicare & Medicaid Services. (2016, 11 09). Professional paper claim form (CMS-1500). Retrieved from CMS.gov: https://www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/1500

CURRENT AS OF 08/03/2026

Revision History

Date Nature of Revision
08/03/2026

Migrated to new platform.