All PlansPrior AuthHigh impact
Precertification Requirements
HMSA·HI·Prior Authorization
We identified it
Oct 4, 2026
Summary
HMSA has added seven new service codes to their precertification requirements list, effective immediately. Billing teams must now obtain prior authorization before submitting claims for CPT code J2789 and HCPCS codes 0631U, 0632U, 0644U, 0645U, 0648U, 0651U, and G0577. Claims submitted without precertification will be denied.
Action Required
Immediately: Billing team must update the prior authorization requirements matrix in the billing system to flag all seven codes (J2789, 0631U, 0632U, 0644U, 0645U, 0648U, 0651U, G0577) as requiring precertification before claim submission. Update encounter templates and provider order entry workflows to alert clinical staff when these codes are used. Contact Provider Services at (808) 948-6330 or 1-800-790-4672 to confirm any additional precertification criteria (medical necessity, clinical criteria, documentation requirements) not detailed in this notice. Establish a verification process to ensure no claims for these codes are submitted to HMSA without documented prior authorization. Failure to obtain precertification will result in claim denials and revenue loss.