Hmsa quest claim forms 2007-2018: Fill out & sign online

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Click ‘Get Form’ to open the hmsa quest claim form in the editor.
Begin by entering the recipient’s identification number in the designated field.
Fill in the recipient’s name, ensuring to include both first and last names.
Input the recipient’s date of birth in the format mm/dd/yyyy.
Enter the pharmacy’s National Provider Identifier (NPI) and its name.
Provide the pharmacy's address, including city and zip code.
Complete the prescriber’s NPI and DEA number if applicable for controlled substances.
Indicate whether there is other drug or liability coverage by checking Yes or No.
Fill out details regarding any accidents related to the claim, including dates and types.
Complete prescription details such as RX number, metric quantity, billing unit, days supply, NDC, diagnosis code, and drug information.
Finally, review all entries for accuracy before submitting your claim by mail to ACS at the provided address.

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Versions	Form popularity	Fillable & printable
2007	4.9 Satisfied (56 Votes)
2002	4.2 Satisfied (121 Votes)

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What is the timely filing limit for HMSA quest?

Participating QUEST Integration providers have one year from the date of service or discharge, whichever is the latter, to file all claims (e.g., initial submissions, resubmissions, adjusted submissions) to HMSA.

Is HMSA Hawaii Medicaid?

In Hawaii, most of the Medicaid services are delivered through MCO. There are five (5) MCO health plans: AlohaCare, HMSA, Kaiser Permanente, Ohana Health Plan, and UnitedHealthcare Community Plan that provides medical and Long Term Services and Support (LTSS) benefits.