FAQs: Provider

FAQs2019-06-05T17:36:46+00:00

HMAA provides access to medical and dental services through the HWMG Provider Network. Following are some common questions we receive from providers. If you have a question that isn’t addressed here, feel free to Contact Us.

How can I participate with HMAA?2019-01-13T10:20:14+00:00

Thank you for your interest in participating! HMAA provides access to medical and dental services through the HWMG Provider Network. To participate with HWMG, please visit the Participate with HWMG page, or contact our Provider Relations Department for assistance. We look forward to hearing from you!

Which clearinghouse does HMAA use?2019-01-13T11:16:18+00:00

HMAA is using Smart Data Solutions (SDS) as its EDI clearinghouse under payor ID 48330.

How do I update my information with HMAA?2019-01-13T10:16:31+00:00

Please complete and submit a Provider Add, Delete, or Change Form to update your name, Tax Identification Number, specialty, address, billing address, etc., or to add or terminate a practitioner from your practice.

How do I contact Smart Data Solutions?2019-01-13T11:16:45+00:00

You may call Smart Data Solutions Monday through Friday from 9 am – 5 pm CST toll-free at (855) 297-4436 or email stream.support@sdata.us to set up a connection.

I received a ZixCorp secure email message from HWMG or HMAA. How do I open or reply to the message?2019-01-13T10:06:30+00:00

To open or reply to a ZixCorp secure email message you received from HWMG or HMAA, view our instructions and frequently asked questions regarding our Secure Message Center.

Where should I send my claims?2019-05-18T01:24:50+00:00

HMAA accepts claims electronically through our partnerships with Smart Data Solutions.

Smart Data Solutions (Payor ID 48330) is HMAA’s EDI clearinghouse for electronic claims. If you are currently sending claims through Tesia PCI or through any Smart Data Solutions’ trading partners, we will continue to receive your claims for payor ID 48330.

You can call Smart Data Solutions Monday through Friday 9 am – 5 pm CST toll-free at (855) 297-4436 or email stream.support@sdata.us to set up a direct connection.

For further information, please view our Electronic Data Interchange (EDI) FAQs section.

If you cannot send claims electronically, you may send paper claims to the following address:

HMAA
P.O. Box 32580
Honolulu, HI 96803-2580

Does HMAA accept claims directly via website?2019-01-13T11:17:13+00:00

In some cases, HMAA may accept direct submission of electronic claims. Please contact us to discuss transmittal options.

Where should I send my claims?2019-05-18T01:26:34+00:00

HMAA accepts claims electronically through Smart Data Solutions (Payor ID 48330). For further information, view our Electronic Data Interchange (EDI) FAQs section. If you cannot send claims electronically, you may send paper claims to the following address:

HMAA
P.O. Box 32580
Honolulu, HI 96803-2580

Who should I contact for questions regarding my contract, fee schedules, and other provider-related services?2019-01-13T11:13:14+00:00

Please contact our Provider Relations Department for questions regarding your contract, fee schedule, changes to practice locations or contact information, and other services including Online for Providers and electronic claims submission.

You may also contact us if you would like to schedule an on-site training with your team.

For all other inquiries, please contact our Customer Service Center.

What if I am already sending claims through Smart Data Solutions for other payors?2019-01-13T11:17:48+00:00

If you already are sending claims through Smart Data Solutions for other payors, you do not need to contact SDS. Just begin submitting claims electronically to HMAA, following SDS’ guidelines.

If you are not currently submitting claims through SDS, you or your billing vendor will need to establish a connection for electronic submission with SDS. You may call Smart Data Solutions Monday through Friday from 9 am – 5 pm CST toll-free at (855) 297-4436 or email stream.support@sdata.us to set up a connection.

Who should I contact for questions regarding my contract, fee schedules, and other provider-related services?2019-01-13T10:29:41+00:00

Please contact our Provider Relations Department for questions regarding your contract, fee schedules, changes to practice locations or contact information, and other provider-related services such as Online for Providers and electronic claims submission.

You may also contact us if you would like to schedule an on-site training with your staff.

For all other inquiries, please contact our Customer Service Center.

How may I obtain a copy of the Provider Administrative Procedure Manual and/or Dental Processing Guidelines?2019-01-13T10:33:14+00:00

To obtain the most up-to-date version of these documents, visit our Provider Forms & Information section, or contact our Provider Relations Department and we will gladly send you a copy.

What if I am already sending claims to another clearinghouse?2019-01-13T11:18:05+00:00

If you currently use a clearinghouse for electronic submission of claims to other payors, you may be able to submit HMAA claims through your existing connection. SDS accepts claims from Claimsnet, Proxymed, Medavant, THIN, ENS, and several others. For assistance, please contact Smart Data Solutions Monday through Friday 9 am – 5 pm CST toll-free at (855) 297-4436 or email stream.support@sdata.us to determine whether your current clearinghouse may be utilized for submission of electronic claims to HMAA.

How may I obtain a copy of the Provider Administrative Procedure Manual?2019-01-13T10:32:11+00:00

To obtain the most up-to-date version of these documents, visit our Provider Forms & Information section, or contact our Provider Relations Department and we will gladly send you a copy.

What dental services require pre-determination?2018-10-31T06:34:59+00:00

Although not mandatory, pre-determinations are recommended for services over $300.

What types of electronic claim formats do HMAA accept?2019-01-13T11:18:21+00:00

HMAA accepts 5010 standard EDI claims through our clearinghouse, Smart Data Solutions.

What medical services require precertification?2019-01-13T11:02:00+00:00

View our Precertification Program list of services that is required under HMAA’s medical plans and subject to change at any time.

How may I obtain a list of specialists to refer my patients to?2019-01-13T11:06:26+00:00

You may go to our Provider Directory to obtain a list of specialists in our network.

How can I be sure that HMAA is receiving our claims?2019-01-13T11:18:39+00:00

You should review the confirmation and rejection reports supplied by your vendor and SDS  each time you transmit claims to HMAA.  These reports should be used to compare your actual submission totals against the totals shown on the reports.  They will confirm which claims have reached their destination and which claims were rejected.  If you do not currently receive these reports or you are unsure about how to use them, please contact your vendor.

Regardless of your EDI vendor, when you send a claim electronically to HMAA, it will be processed through SDS.  At SDS, the claim goes through a set of standard edits to make sure the claim is error-free.  If the claim meets these standard requirements, SDS accepts the claim and forwards it to HMAA.  If the claim is missing required information or does not meet SDS’ edits, SDS rejects the claim and the claim does not reach HMAA.

What electronic tools does HMAA offer to providers?2019-01-13T11:11:12+00:00

We are pleased to offer a suite of electronic tools at no cost to participating providers to maximize efficiency for your practice.

Why is HMAA not receiving our claims transmissions?2019-01-13T11:19:04+00:00

The problem could result from several different causes. Please review the steps below.

  1. Routinely review your confirmation and rejection reports to ensure all of your claims were transmitted to HMAA by your vendor (if applicable) and SDS.
  2. Ensure eligible claims are flagged in your system to be sent electronically to SDS using HMAA’s payor ID, 48330.
  3. Check with your EDI vendor to verify they are receiving all of your claims.
  4. Ask your EDI vendor to contact SDS to verify that all of your claims were received.
  5. Some vendors require an additional unique number for electronic routing, or a reference regarding the payor address/name information to determine electronic routing. Please check with your vendor regarding their specific requirements.
  6. If all of the above have been verified but HMAA is still not receiving your claims, please contact our Provider Relations Department.
What electronic tools does HMAA offer to providers?2019-11-08T17:13:12+00:00

We are pleased to offer a suite of electronic tools at no cost to participating providers to maximize efficiency for your practice.

Why is HMAA receiving paper claims from us when we transmit electronically?2019-01-13T11:19:31+00:00

Some vendors offer a service that automatically converts electronic claims to paper if they are rejected during transmission to the next vendor.  Review your SDS rejection reports and contact your vendor to discuss how they handle rejected claims.

Should I submit the same claims electronically AND by paper just to be sure they are received?2019-01-13T11:20:00+00:00

Please choose either paper or electronic filing, not both. Filing twice, by paper and electronically, will result in duplicate claim handling by HMAA. Note: This does not apply to specific requests by HMAA for paper claims with additional attachments that must be submitted by paper.

Does HMAA provide Electronic Remittance Advice (ERA) and Electronic Payment Services?2019-01-13T11:21:04+00:00

Yes, we offer ERA and ePayment services through Zelis Payments. Contact our Provider Relations Department for further information.

What should I do if I suspect someone is committing health care fraud, waste, or abuse?2018-12-28T07:34:24+00:00

If you suspect health care fraud, waste, or abuse by an HMAA group, member, provider, or other individual or entity, report it to HMAA at stopfraud@hmaa.com or contact our Customer Service Center.

Let us know how we can improve our tools and services by completing a Satisfaction Survey.