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Hawaii 240 request reconsideration 2025

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The document is a Request for Reconsideration form used by providers to contest reimbursement amounts for specific services under Hawaii Medicaid. It outlines the process for submitting a reconsideration request, including required information and documentation, and specifies that requests must be made within sixty days of payment or adjudication. The form also details the steps taken by the Hawaii Medicaid Fiscal Agent to verify claims and forward them to Med-QUEST for final determination.

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2014	4.8 Satisfied (106 Votes)

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