Forms and Information: Providers
Below is a list of printable forms and information for our Providers' convenience.
Claim Submission
Network Participation
- Provider Contracting Application
- Provider Add, Delete or Change Form
- Registration Form for Providers - To be completed by non-physician
- W-9 Form
Pre-Certification / Notification
Pre-Certification Line: 808-791-7505
- Pre-Certification Program:
- Pre-Certification Request Form
- Behavioral Health Pre-Certification Request Form
- Clinical Information Sheet
- Outpatient Psychological Testing Request Form
- Pregnancy Notification Form
Provider Information
Administrative Procedure Manuals
Honolulu, HI 96813