Frequently Asked Questions: Provider Contracting

Whom do I contact with questions about the Participating Provider Agreement?

When you become a participating provider, you are assigned a Provider Services Field Representative or Coordinator who works with you on contracting issues. In that one-to-one relationship, he or she can help answer questions specific to your situation and collaboratively resolve any problems that may arise. For assistance in contacting the Field staff, call 808-948-6330 on Oahu or 1-800-790-4672 from the Neighbor Islands.

Does my agreement apply to new plans introduced by HMSA?

Yes. Currently, there are different types of HMSA plans for which you can contract: Preferred Provider Plans (PPP), Health Maintenance Organization (HMO) plans, Medicare-based plans and the HMSA Plan for QUEST Members. If a variation is added to one of these basic plan types, your agreement for that plan type will apply. (See HMSA Plans for more information.)

How often must I renew my contract with HMSA?

Contracting periods vary depending on your specialty and your preference. Some contracts are evergreen – they renew automatically unless terminated by you or HMSA. Other contracts may have renewal periods of two to five years.

In general, the recontracting process is similar for most providers. When an agreement is about to expire, the provider may be sent a draft contract to review, especially if it includes material changes since the last agreement. (Material changes are highlighted on a separate sheet.) After all provider input is received, and revisions made as appropriate, the final agreement is mailed. During this time, the Field Representative or Coordinator is available to help the provider through the recontracting process.

If a provider does not renew the agreement by the contract expiration date, HMSA will send a termination notice by certified mail. Following termination of an agreement, a provider may re-enroll as a participating provider. However, if more than 30 days has lapsed since the prior agreement’s expiration date, the provider must go through the credentialing process again.

Can I change my marketing specialty?

Your licensure, education, board certification and experience determine your marketing specialty, which is listed in HMSA’s hard-copy and online provider directories. If you are board-certified in two specialties, you may request to be listed under both specialties in the directories.

How does licensing impact my participating status?

State law requires that you have a current, valid license to practice. In addition, licensure is an essential component of your agreement with HMSA.

Both the state and HMSA will notify you when your license is about to expire. HMSA will request that you submit evidence of your license renewal. A reminder will be mailed, as appropriate.

If your license lapses, your Participating Provider Agreement with HMSA will be terminated according to the terms of the agreement, via certified mail.

What happens if I decide to terminate my contract with HMSA?

Generally, as a participating provider, you may terminate your agreement by giving HMSA at least 60 days’ written notice. Providers terminating their agreements bear certain responsibilities related to Continuity of Care for their patients. Also, when providers terminate their agreements, they generally must notify their patients who are HMSA members at least 30 days prior to the termination date.

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