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.
Medicare contractor and active LCDs in Hawaii
Noridian Healthcare Solutions, LLC is the Medicare A/B MAC for Hawaii: Part A and Part B fee-for-service claims from Hawaii go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to Noridian Healthcare Solutions, LLC as the DME MAC. Home health and hospice claims are processed by Wellpoint Federal. In the current Medicare Coverage Database export, 171 active LCDs from these contractors apply to Hawaii claims.
- Noridian Healthcare Solutions, LLC
A/B MAC (Part A and Part B claims); DME MAC (durable medical equipment and supplies)
- Wellpoint Federal
Home health and hospice MAC
Selected active Noridian Healthcare Solutions, LLC policies for Hawaii
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L38814 MolDX: Minimal Residual Disease Testing for Cancer
- L39240 Epidural Steroid Injections for Pain Management
- L38902 Wound and Ulcer Care
- L34211 Trigger Point Injections (TPI)
- L35526 B-type Natriuretic Peptide (BNP) Testing
- L38709 Computed Tomography Cerebral Perfusion Analysis (CTP)
- L40255 Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices
- L34194 Blepharoplasty, Eyelid Surgery, and Brow Lift
- L34215 Lab: Flow Cytometry
- L35136 Spinal Cord Stimulators for Chronic Pain
- L36538 Treatment of Males with Low Testosterone
- L36678 Lab: Bladder/Urothelial Tumor Markers
Equipment, home health and hospice policies that apply in Hawaii
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L33792 Wheelchair Options/Accessories
- L33797 Oxygen and Oxygen Equipment
- L33393 Hospice - Determining Terminal Status
Steps to confirm which LCD governs a claim · Every active LCD by contractor
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.