Hawaii 240 request reconsideration 2026

1. Click ‘Get Form’ to open the Hawaii 240 Request for Reconsideration in the editor.
2. Begin by entering the 'Date of Request' at the top of the form. This is essential for tracking your submission.
3. Fill in your 'Provider Name', 'Contact Name', and 'Provider ID #' accurately to ensure proper identification.
4. Provide your contact details, including 'Provider Phone #', 'Provider Fax #', and 'Provider Address'. This information is crucial for communication regarding your request.
5. Enter the 'Claim Reference Number' and 'HAWI ID #' to link your reconsideration request to the specific claim.
6. List the 'Date(s) of Service' related to your claim, ensuring all relevant dates are included.
7. Attach any necessary documents by listing them in the 'List of Attached Documents' section. This supports your justification.
8. In the 'Reconsideration Justification' field, provide a clear explanation of why you believe a reconsideration is warranted.
9. Complete the section for 'Date FA Completed Research' and sign off with your name in the designated area before submitting.

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