Providers

• CMS1500
• UB-04
• ADA Dental
• Employee Assistance Program (EAP)
• Third-Party Liability Questionnaire  and  Agreement
  • HMAA
  • Hawaii Electricians Health and Welfare Fund
  • Charter Communications (formerly Oceanic Time Warner Cable)
• IRS Form W-9

• Dental Claim Submission Requirements (HMAA)
• Dental Procedure Guidelines (HMAA)

• List  of  Services  and  Supplies  Requiring  Precertification
  • HMAA
  • Hawaii Electricians Health and Welfare Fund
  • Charter Communications
• Forms
  • Precertification Request for Medical Services
  • Precertification Request for Prescription Drugs (HMAA and Charter Communications)
  • Clinical Information Sheet
  • Pregnancy Notification Sheet
  • Interisland Access to Care Program – Travel Request Form (HMAA and Charter Communications)

Our pharmacy benefit manager, OptumRx, helps members manage their prescriptions. View further information.

• Provider Add, Delete or Change Form
• Provider Contracting Applications
• Provider Credentialing Applications

• To file a request for reconsideration, contact the following:
  • Customer Service Center regarding claim payments
  • The applicable reviewer regarding precertification (refer to the Precertification Program List)
• To file a complaint, contact our Customer Service Center or Provider Relations.
• To file an appeal, complete our Appeal Request Form. Following are the appeals procedures based on type of dispute:
  • Disputes Involving Administrative Matters
  • Disputes Involving Network Termination or Action by HWMG Related to Professional Competency

We provide language translation services as an added communication support for assistance to our non-English speaking customers while on the phone or face-to-face with one of our employees or participating providers. Participating providers may call our Customer Service Center should a translator be needed when health care services are rendered to our non-English speaking members.

• Administrative Manual for Participating Providers
• Provider Email Updates
  • 3/13/23: COVID-19 Public Health Emergency
  • 9/30/22: HMAA and HWMG Address Change
• Provider Satisfaction Survey