Working with HMSA
Durable Medical Equipment
Review durable medical equipment (DME) guidelines, including coverage criteria, documentation requirements, and billing practices for compliant reimbursement.
EDI Contracts
Please print and complete the appropriate EDI Contract form(s) below and return to HMSA via fax at 948-6008.
Electrocardiogram Performed in the Emergency Department
Guidelines for electrocardiograms performed in the emergency department, including billing requirements, interpretation, and reimbursement guidelines.
Emergency Room Services
Guidelines for emergency room services, including coverage, billing requirements, and reimbursement for emergency care.
Emergent/Urgent Care
Guidelines for emergent and urgent care services, including coverage, billing requirements, and reimbursement guidelines.
Entering Days' Supply
Learn HMSA guidelines for entering days’ supply on claims, including calculation methods, billing requirements, and tips to ensure accurate processing.
Entering Member Information
Learn how to enter member information on HMSA claims, including required fields, data accuracy tips, and guidelines for proper processing.
Exclusions - Vision
Review vision care exclusions, including non-covered services, materials, and limitations to help ensure accurate billing and member understanding.
Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)
Explore the Pay for Quality Program Guide for Federally Qualified Health Centers and Rural Health Clinics, including measures, incentives, and program requirements.
FQHC RHC Full Code Set – 2024
Explore the FQHC/RHC full code set for 2024, including covered codes, billing requirements, and guidance for accurate claims submission.