Hmsa hmo referral form: Fill out & sign online

Here's how it works

01. Edit your hmsa hmo referral form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send hmsa prior authorization form via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out hmsa form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the HMSA Precertification Request in the editor.
Begin by filling out the 'A. MEMBER INFORMATION' section. Enter the patient's name, membership number, date of birth, subscriber's name, and phone number accurately.
Proceed to 'B. ICD-9-CM/ICD-10-CM DIAGNOSIS CODE(S)'. Input the relevant diagnosis codes that correspond to the patient's condition.
In 'C. PROCEDURE/SERVICE/TREATMENT INFORMATION', select the place of service (e.g., inpatient or outpatient) and provide CPT/HCPCS codes along with service dates and modifiers as necessary.
Complete 'D. PROVIDER INFORMATION' by entering details for both requesting and servicing providers, including names, IDs, addresses, and contact numbers.
Finally, add any additional notes in 'E. General Comments' if needed and ensure all required fields are filled before submitting.

Start using our platform today for free to streamline your HMSA form completion!

See more hmsa form versions

We've got more versions of the hmsa form form. Select the right hmsa form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (101 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

How do I sign my hmsa precertification request form for free?

Most eSignature services require users to have a paid subscription. With DocHub, there are two options for you to add an electronic signature to your hmsa precertification request form without being charged:

You can do it during a 7-day trial period;
You can subscribe to a free plan.

The second option, though, has limitations on the number of signatures, sign requests, emails, and documents for adjusting available per month. You can check for full information here.

How do you edit hmsa pa form on iOS?

You can easily edit and complete your hmsa pa form on any iOS gadget. Open an internet browser of your liking, go to the DocHub website, authorize or create a new account, add your file for editing, and make your desired alterations. Our service is mobile-friendly, so using its functions on your smartphone will be a no-brainer, even on the first try.

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.

What HMSA stands for?

Hawaii Medical Service Association (HMSA) is a nonprofit health insurer in the state of Hawaii. HMSA was founded in 1938, is an independent licensee of the Blue Cross Blue Shield Association, and is the largest insurer in the state of Hawaii serving more than 700,000 people. Hawaii Medical Service Association.

Can I use HMSA on the Mainland?

Your HMSA PPO plan provides benefits for services on the Mainland.

hmsa precertification form

Hmsa form pdf Hmsa form online HMSA Prior Authorization Form PDF Hmsa form download Hmsa form ppo HMSA membership Report Form HMSA enrollment form HMSA QUEST Referral Form PDF

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

Can HMSA be used out of state?

HMSA members, except those covered by the HMSA Children's plan, have benefits for medical services delivered outside the United States through the BlueCard Worldwide network. Note: The HMSA Children's Plan does cover emergency services, but urgent care isn't a covered benefit.

Does Straub take HMSA?

Members can see a doctor at Straub Clinic & Hospital, urgent care clinics statewide, or on a smartphone or tablet with HMSA's Online Care®. They can also speak to a nurse at CVS/ minuteclinic®, the medical clinic in Longs Drugs stores on Oahu.

Is HMSA worldwide?

What you need to know when getting emergency and non-emergency care while traveling outside the U.S. HMSA members have access to the largest health provider network in Hawaii and more than 500,000 preferred Blue Cross and Blue Shield providers nationwide and across the globe.

Does HMSA have an app?

Enrolling in Online Care is easy. From a mobile device: Search for HMSA's Online Care in the Apple 3 or Android 4 app store. Download and open the free app.

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.

Hmsa form 2025

Here's how it works

How to use or fill out hmsa form with our platform

See more hmsa form versions

Complete this form in 5 minutes or less

Got questions?

How do I sign my hmsa precertification request form for free?

How do you edit hmsa pa form on iOS?

Is HMSA Hawaii Medicaid?

What HMSA stands for?

Can I use HMSA on the Mainland?

Complete this form in 5 minutes or less

People also ask

Can HMSA be used out of state?

Does Straub take HMSA?

Is HMSA worldwide?

Does HMSA have an app?

Is HMSA Hawaii Medicaid?

hmsa authorization form

Try more PDF tools