Hawaii Medicaid — Hawaii Med-QUEST (Medicaid / CHIP)
| Program name | Hawaii Med-QUEST (Medicaid / CHIP) |
|---|---|
| Provider portal | https://medquest.hawaii.gov |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Hawaii Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Hawaii
The Blue Cross Blue Shield Association licensee in Hawaii is HMSA (Hawaii Medical Service Association). See the HMSA payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in Hawaii
The dominant commercial insurers operating in Hawaii, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Hawaii
Hawaii Med-QUEST (Medicaid / CHIP) contracts with the following managed-care organizations to administer Medicaid benefits in Hawaii. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
State-specific regulations affecting Hawaii billing
- HRS §431:13-108 (prompt pay — 30 days electronic clean claim, 15% interest)
- HRS §431M (mental health parity)
- HRS §323D-65 (hospital community benefit / charity care)
Provider licensing & enrollment in Hawaii
Providers enroll via Med-QUEST Division (MQD) Provider Enrollment. QUEST Integration MCOs credential separately; CAQH ProView accepted.
Major health systems headquartered in Hawaii
| Health system | Headquarters |
|---|---|
| Hawaii Pacific Health | Honolulu, HI |
| The Queen's Health Systems | Honolulu, HI |
| Kaiser Permanente Hawaii | Honolulu, HI |
| Adventist Health Castle | Kailua, HI |
| Kuakini Medical Center | Honolulu, HI |
Frequently asked questions — Hawaii billing
What is the Hawaii Medicaid program called?
Hawaii's Medicaid program is known as Hawaii Med-QUEST (Medicaid / CHIP). Providers enroll and manage claims through the provider portal at https://medquest.hawaii.gov.
What is the Hawaii Medicaid timely filing limit?
Hawaii Med-QUEST (Medicaid / CHIP) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Hawaii's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Hawaii Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Hawaii Med-QUEST (Medicaid / CHIP). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Hawaii?
The dominant commercial payers in Hawaii include HMSA, Kaiser Permanente, UnitedHealthcare, Aetna, Humana, along with the BCBS licensee HMSA (Hawaii Medical Service Association). Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Hawaii?
Hawaii Med-QUEST (Medicaid / CHIP) contracts with 4 Medicaid MCOs tracked in the QuickIntell registry, including HMSA, Kaiser Permanente, UnitedHealthcare, WellCare. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Hawaii?
Hawaii has 3 tracked state-level statutes that affect medical billing and RCM: HRS §431:13-108 (prompt pay — 30 days electronic clean claim, 15% interest); HRS §431M (mental health parity); HRS §323D-65 (hospital community benefit / charity care). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Hawaii with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Hawaii Med-QUEST (Medicaid / CHIP) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Hawaii Medicaid and the member ID card before submission.