What insurance policy changes affect Hawaii providers?

This page tracks changes from major payers (including Medicaid managed care, commercial insurers, and Medicare Advantage plans) that explicitly apply to Hawaii. Changes include prior authorization updates, billing code additions or deletions, and reimbursement rate revisions.

How often are Hawaii policy changes updated?

Our scrapers run daily and publish new findings within 24 hours of detection. Each change includes an effective date where stated so you can prioritize what requires immediate action.

How do I get alerted to new Hawaii insurance policy changes?

Create a free alert on PolicyChanges.app and filter by state to Hawaii. You will get an email when new matching changes are detected: daily or weekly, your choice, on every plan.

PAYER POLICY CHANGES

Hawaii Insurance & Medicaid Policy Updates

Hawaii providers face a continuous stream of payer policy changes: coverage edits, prior authorization expansions, billing code revisions, and Medicaid reimbursement updates that affect day-to-day practice operations. This page surfaces every tracked policy change that explicitly names Hawaii, so your billing and compliance teams can act before the effective date, not after a claim denial.

HMSA · Effective Dec 1, 2026High impact
HealthPro News – October 2026
HMSA's October 2026 provider newsletter, issued Oct. 1, 2026, lists several changes with different dates. Effective Jan. 1, 2027, HMSA will no longer cover Transitional Care Management (TCM) codes 99495 and 99496 for commercial and QUEST members, while TCM remains a covered benefit for Medicare members when CMS requirements are met. Effective Dec. 1, 2026, commercial plans will require blood and blood products to be billed with Revenue Code 038X and the applicable HCPCS code, and blood processing and storage services with Revenue Code 039X.
HMSA · Effective Jan 1, 2027High impact
ACA Individual Network Change
Effective January 1, 2027, ACA Individual plans will transition to a Hawaii-only provider network. Out-of-state coverage will be limited to emergency services, urgent care, and prior-authorized medically necessary services unavailable in Hawaii. Non-emergency, non-urgent out-of-state services will no longer be covered.
HMSA · Effective Jan 1, 2027High impact
Changes to ASAM 3.5 Residential Treatment Authorizations
Effective January 1, 2027, HMSA will change ASAM 3.5 Residential Treatment authorization procedures for QUEST members aged 21-64. Initial authorizations will be limited to 15 days, with mandatory continued-stay reviews required thereafter based on clinical presentation, treatment progress, discharge barriers, and ASAM criteria.
UnitedHealthcare · Effective Jan 1, 2027High impact
New oncology prior authorization code updates
Effective January 1, 2027, UnitedHealthcare is adding prior authorization requirements for 11 HCPCS oncology medication codes when administered in outpatient settings for cancer treatment. These codes include busulfan, leucovorin calcium, luspatercept, dexrazoxane, dinutuximab, octreotide, triptorelin, omidubicel, zoledronic acid, and cyclosporine. This change applies across commercial, Medicare Advantage, Medicaid, and Individual Exchange plans.
HMSA · Effective Jan 1, 2027Medium impact
HealthPro News – November 2026
HMSA is implementing several policy changes effective January 1, 2027, including denial of APCM services on institutional (UB-04) claims, coverage expansions for multiple sclerosis HCT and cervical cancer screening, removal of prior authorization wait periods for TMS, and updates to vaccine Maximum Allowable Charges effective October 1, 2026. The practice must stop billing APCM on UB-04 claims for dates of service on or after January 1, 2027, and update clinical documentation practices for acute bronchitis to reflect antibiotic avoidance guidance.
UnitedHealthcare · Effective Nov 1, 2026High impact
Medicaid: Paper submissions no longer accepted
Effective November 1, 2026, UnitedHealthcare Community Plan (Medicaid) in Hawaii, New Mexico, Rhode Island, and Wisconsin will no longer accept paper submissions for post-service appeals. All appeals must be submitted electronically via the UnitedHealthcare Provider Portal or API. Paper appeals will not be reviewed.
Humana · Effective Oct 1, 2026High impact
Molecular Biomarkers for Prostate Cancer Risk Stratification - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage coverage policy for molecular biomarker tests used in prostate cancer risk stratification (effective 10/1/2026). The policy establishes coverage criteria for tests like ArteraAI, EpiSwitch, IsoPSA, MyProstateScore 2.0, ProMark, and ProsTAV, with coverage determinations based on MAC-specific LCDs/LCAs that vary by geographic jurisdiction. Billing teams must identify the correct MAC jurisdiction and apply the corresponding LCD requirements for each test ordered.
Humana · Effective Oct 1, 2026High impact
Bariatric Surgery - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage bariatric surgery coverage policy (HUM-1020-005) effective October 1, 2026, that outlines coverage determinations, limitations, and coding requirements for various bariatric procedures. The policy applies Humana's Medicare Advantage coverage standards and references applicable MAC Local Coverage Determinations by geographic jurisdiction, with specific rules varying by state and MAC region.
Humana · Effective Sep 1, 2026High impact
Spinal Fusion Surgery - Medicare Advantage (Revised)
This is a revised Medicare Advantage medical coverage policy for spinal fusion surgery (effective 09/01/2026) that consolidates coverage determination, limitations, coding information, and evidence summaries for cervical, lumbar, and thoracic spinal fusion procedures. The policy references multiple MAC-specific Local Coverage Determinations (LCDs) across geographic jurisdictions and outlines covered procedures including traditional fusion, minimally invasive approaches (DLIF, XLIF, MITLIF), sacroiliac joint fusion, and interlaminar fusion techniques. Billing teams must align claims submission with the applicable MAC LCD based on patient location and ensure procedures meet specific medical necessity criteria outlined in the referenced determinations.
Humana · Effective Sep 1, 2026High impact
Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage coverage policy for Benign Prostatic Hyperplasia treatments effective September 1, 2026. The policy outlines coverage determinations for multiple BPH treatment modalities including surgical procedures (TURP, prostatectomy, laser therapies), temporary implanted devices, stents, and diagnostic testing. The policy references multiple MAC-specific Local Coverage Determinations (LCDs) that vary by geographic jurisdiction, requiring billing teams to verify applicable coverage rules based on patient location.
Humana · Effective Sep 1, 2026High impact
Ambulatory Cardiac Monitoring Devices - Medicare Advantage (Revised)
Humana Medicare Advantage has revised its Ambulatory Cardiac Monitoring Devices policy effective September 1, 2026. The policy provides updated coverage guidance for various cardiac monitoring technologies (Holter monitors, patch recorders, external loop monitors, implantable loop recorders, and mobile cardiac outpatient telemetry) with MAC-specific coverage determinations by geographic jurisdiction. The policy document appears incomplete but establishes that medical necessity determinations will follow applicable NCDs and LCDs based on the member's jurisdiction.
Humana · Effective Aug 6, 2026High impact
Neuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage coverage policy for neuroablative techniques used to treat chronic pain, effective 08/06/2026. The policy defines coverage criteria, eligible procedures (including radiofrequency ablation, cryoablation, chemical neurolysis, and specialized devices like Intracept), and references MAC-specific LCDs and billing codes by geographic jurisdiction. Billing teams must verify applicable MAC guidelines for their state and ensure claims comply with local coverage determinations.
Humana · Effective Aug 6, 2026High impact
Neuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage policy on neuroablative techniques for chronic pain management, effective 08/06/2026. The policy defines covered denervation procedures (radiofrequency ablation, cryoablation, facet denervation, basivertebral nerve ablation, and others) and references MAC-specific LCDs and NCDs that vary by geographic jurisdiction. Billing teams must verify applicable MAC requirements for their region before processing claims for these procedures.
Humana · Effective Aug 3, 2026High impact
Genetic Testing for Hereditary Cancer - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage policy on genetic testing for hereditary cancer syndromes, effective August 3, 2026. The policy establishes coverage guidelines for germline genetic testing across multiple cancer types (melanoma, gastric cancer, neuroendocrine tumors, renal cell carcinoma, and others) and references specific MAC-based Local Coverage Determinations (LCDs) that vary by geographic jurisdiction. Billing teams must verify applicable MAC jurisdiction and LCD requirements before processing claims.
Humana · Effective Aug 3, 2026High impact
Breast Reconstruction - Medicare Advantage (Revised)
Humana Medicare Advantage has revised its breast reconstruction coverage policy (effective 08/03/2026) to clarify medical necessity criteria for reconstruction procedures following mastectomy, trauma, or congenital abnormalities. The policy applies MAC-specific Local Coverage Determinations (LCDs) by geographic jurisdiction and establishes criteria for determining coverage of implant removal, reduction mammaplasty, and related procedures. Billing teams must identify the appropriate MAC jurisdiction for each claim and apply the correct LCD requirements.
Humana · Effective Aug 3, 2026High impact
Breast Excision and Mastectomy - Medicare Advantage (Revised)
Humana Medicare Advantage has updated its Breast Excision and Mastectomy policy (HUM-1254-009) effective 08/03/2026. This revised policy clarifies coverage criteria for breast lesion excisions (CPT 19120, 19125), partial mastectomies (CPT 19301, 19302), and gynecomastia mastectomy (CPT 19300) across multiple MAC jurisdictions. The policy establishes specific medical necessity criteria based on biopsy results, lesion characteristics, and anatomical considerations, and applies jurisdiction-specific Local Coverage Determinations (LCDs) for Medicare Administrative Contractors.
Humana · Effective Aug 3, 2026High impact
Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)
This is a comprehensive Medicare Advantage policy for Benign Prostatic Hyperplasia (BPH) treatments that became effective on August 3, 2026. The policy outlines coverage for multiple surgical and minimally invasive treatment modalities including TURP, laser therapies, temporary implanted devices, and stents, with specific coverage determinations varying by MAC jurisdiction. Billing teams must verify applicable MAC-specific LCDs and NCDs by geographic location before processing BPH treatment claims.
Humana · Effective Jul 1, 2026High impact
Breast Imaging - Medicare Advantage (Revised)
This is a revised Medicare Advantage policy for breast imaging (effective 07/01/2026) that establishes coverage criteria for mammography, digital breast tomosynthesis, breast MRI, and ultrasound. The policy clarifies medical necessity requirements and references applicable Local Coverage Determinations (LCDs) by MAC jurisdiction. Billing teams must verify which MAC jurisdiction applies to their geographic location to determine specific coverage rules.
UnitedHealthcare · Effective Dec 1, 2025High impact
Medicaid: Required documentation changes for hip and knee total joint replacements
UnitedHealthcare Community Plan (Medicaid) now requires enhanced medical documentation for prior authorization of total hip and knee joint replacement surgeries (CPT 27447, 27130, 27132) when performed for osteoarthritis. New requirements include detailed imaging reports with specific findings and provider specialties who interpreted images, rolling out across multiple states with different effective dates.
UnitedHealthcare · Effective Oct 3, 2025High impact
Hawaii Medicaid: Get ready for paperless claim-related documents and submissions starting Oct. 3
Starting October 3, 2025, Hawaii Medicaid providers will no longer receive paper appeal letters, claim letters, and virtual card payment statements - these will only be available through the UnitedHealthcare Provider Portal. All claim reconsiderations and medical appeals must be submitted electronically through the portal.
HMSA · Identified Oct 4, 2026High impact
Precertification Requirements
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.
HMSA · Identified Oct 4, 2026High impact
Claim Documentation Requirements
HMSA has updated its Claim Documentation Requirements policy to specify which billing codes require supporting documentation for claims processing. The complete list of affected codes is now available on the HMSA provider portal. Billing teams must review this list to ensure all claims include proper documentation to avoid denials.
HMSA · Identified Oct 4, 2026High impact
Provider Directory
HMSA requires all providers to submit quarterly attestations confirming the accuracy of their practice information in the provider directory, effective immediately with the next deadline of November 30. Providers must verify and update all directory data points (name, specialty, office locations, contact information, board certifications, new patient status, etc.) on the HMSA provider self-service portal or via email. Failure to complete attestation by the quarterly deadline will result in removal from the provider directory.
UnitedHealthcare · Identified Sep 2, 2026High impact
Hereditary cancer testing policy reminder
UnitedHealthcare is reminding providers that multigene RNA panel testing for hereditary cancer is considered unproven and will be denied. Only DNA-only hereditary cancer panels and single-gene RNA testing remain covered under applicable medical policy and prior authorization requirements.
UnitedHealthcare · Identified Aug 2, 2026High impact
Hawaii Medicaid: Updated payment policy for acute care readmissions
UnitedHealthcare Community Plan of Hawai'i has implemented a formal readmission review process for acute care facilities to validate claims for readmissions occurring within 31 days of discharge. The billing team must now prepare comprehensive medical records for both initial and subsequent admissions within 60 days when requested, and understand the criteria used to determine payment appropriateness based on premature discharge, preventability, and billing accuracy.
HMSA · Identified Jun 20, 2026High impact
Suspension of Prior Authorization Reviews For Maui County
HMSA has temporarily suspended all prior authorization reviews for healthcare providers serving patients in Maui County. This means services that normally require prior authorization approval can proceed without waiting for HMSA approval during this suspension period.
Medicare/CMS - LCD · Effective Nov 5, 2026Medium impact
Prostate Cancer Detection with IsoPSA®
CGS Administrators' LCD L39284 (Prostate Cancer Detection with IsoPSA®), revised in R4 dated 11/05/2026, provides limited coverage for the IsoPSA® blood test for men 50 and older with a confirmed PSA above 4 and up to 25 ng/mL and no relative contraindication to biopsy such as less than a 10-year life expectancy. The source states its annual review made no changes, and the stated effective date of 11/5/2026 is already before the analysis date of 2026-11-06, so these criteria are already in effect and should be checked for current applicability. The practice should align IsoPSA® orders and claims with these indications and the confirmed-PSA requirement.
Humana · Effective Nov 1, 2026Medium impact
Neuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)
Humana Medicare Advantage revised its neuroablative techniques for chronic pain policy effective 11/01/2026. The policy update describes coverage criteria, limitations, and coding guidance for multiple denervation procedures (radiofrequency ablation, cryotherapy, facet denervation, basivertebral nerve ablation, and other neuroablative techniques). The practice must verify applicable MAC LCDs by geographic jurisdiction, obtain prior authorization as required, and ensure claims are submitted with correct coding and documentation.
Humana · Effective Oct 1, 2026Medium impact
Noninvasive Tests for Hepatic Fibrosis - Medicare Advantage (Revised)
This is a Medicare Advantage policy update (effective 10/01/2026) covering noninvasive tests for hepatic fibrosis, including imaging-based tests (MRE, qMRA) and blood-based biomarker panels (ELF, FIB-4, FibroSure, LiverFASt, NIS4, OWLiver, TruD, HepQuantDuO). The policy establishes coverage determination criteria for these tests across multiple MAC jurisdictions. The document provided is incomplete and does not contain the full coverage determination criteria, medical necessity requirements, or specific billing code guidance needed for implementation.
Humana · Effective Oct 1, 2026Medium impact
Low Frequency, Noncontact, Nonthermal Ultrasound for Wound Care - Medicare Advantage (Revised)
This is a revised Medicare Advantage policy for low frequency, noncontact, nonthermal ultrasound (MIST Therapy) for wound care, effective October 1, 2026. The policy clarifies medical necessity criteria across multiple MAC jurisdictions, requiring that standard wound care demonstrate no improvement or be contraindicated before this therapy is covered. Billing teams must ensure claims include proper documentation of failed standard care and route requests through applicable regional MACs.
UnitedHealthcare · Effective Oct 1, 2026Medium impact
New oncology prior authorization code update
Effective October 1, 2026, UnitedHealthcare will require prior authorization for HCPCS code J2860 (siltuximab injection) when administered in outpatient settings for cancer treatment. This applies to all UnitedHealthcare plan types including commercial, Medicare Advantage, Medicaid, and Exchange plans.
UnitedHealthcare · Effective Sep 1, 2026Medium impact
Medicaid: New prior authorization codes for VBT and extremity prosthetics services
Starting September 1, 2026, UnitedHealthcare will require prior authorization for vertebral body tethering (VBT) codes and upper/lower extremity prosthetics codes across multiple state Medicaid plans. The VBT codes were previously classified as unproven but are now considered proven in certain clinical circumstances, while the prosthetics codes are newly established AMA codes.
Humana · Effective Aug 30, 2026Medium impact
Molecular Diagnostic Assays and Breath Testing for Transplant Rejection - Medicare Advantage (Revised)
Humana Medicare Advantage has updated its policy on molecular diagnostic assays and breath testing for transplant rejection, effective 08/30/2026. This policy establishes coverage criteria and references for gene expression profiling tests, antigen-specific T-cell function assays, breath testing (BMAC/Heartsbreath), and donor-derived cell-free DNA tests used to monitor organ transplant recipients. Billing teams must verify MAC-specific Local Coverage Determinations (LCDs) by geographic jurisdiction, as coverage and coding requirements vary significantly by region.
Humana · Effective Aug 3, 2026Medium impact
Liquid Biopsy - Medicare Advantage (Revised)
Humana Medicare Advantage has updated its Liquid Biopsy coverage policy (Policy HUM-1151-014), effective 08/03/2026. This policy establishes coverage criteria for liquid biopsy tests (blood-based biomarker analysis for cancer detection and treatment monitoring) across multiple jurisdictions under Medicare Administrative Contractors. The policy requires medical necessity documentation and adherence to MAC-specific Local Coverage Determinations, with coverage determined through analytical/clinical validity standards and DEX Registry evaluation where CMS guidance is absent.
Humana · Effective Jul 1, 2026Medium impact
Coronary CT Angiography, Fractional Flow Reserve with CT and Adjunctive Testing - Medicare Advantage (Revised)
This is a Medicare Advantage policy revision (effective 07/01/2026) for Coronary CT Angiography, Fractional Flow Reserve with CT, and adjunctive cardiac testing. The policy establishes that Humana follows applicable Local Coverage Determinations (LCDs) by MAC jurisdiction for CCTA (CPT 75574) and FFRCT (CPT 75580), with specific LCD guidance for each geographic region. Billing teams must ensure prior authorization and medical necessity documentation align with the applicable LCD in the patient's service area.
UnitedHealthcare · Effective Jul 1, 2026Medium impact
Medicaid: View new genetic and molecular code updates
UnitedHealthcare is updating prior authorization and advance notification requirements for genetic and molecular procedure codes effective July 1, 2026, to comply with American Medical Association code changes. This affects multiple UnitedHealthcare Community Plans across 18 states.
UnitedHealthcare · Effective Jul 1, 2026Medium impact
Medicaid: Prior authorization required for certain transcatheter heart valve procedures
Starting July 1, 2026, UnitedHealthcare Community Plans (Medicaid) will require prior authorization for transcatheter heart valve procedures using codes 0569T and 0570T. These codes were previously classified as unproven but are now considered proven in certain clinical circumstances requiring medical necessity review.
Humana · Effective Mar 2, 2026Medium impact
Advanced Imaging of the Head and Neck - Medicare Advantage (Revised)
Humana has revised their Medicare Advantage policy for advanced imaging of the head and neck, establishing specific medical necessity criteria for MRA and MRI procedures. The policy provides jurisdiction-specific coverage determinations and clarifies when high-risk intracranial aneurysmal screening MRA is considered medically necessary.
UnitedHealthcare · Effective Feb 1, 2026Medium impact
AARP Medicare Supplement: Change to overpayment reimbursement process
AARP Medicare Supplement plans from UnitedHealthcare will automatically offset overpayments from future ACH electronic payments instead of sending letters requesting refunds. This streamlined process applies to providers receiving electronic payments through Optum Pay in 33 specified states.
HMSA · Effective Oct 1, 2025Medium impact
Telehealth
HMSA updated its telehealth policy to clarify coverage for audio-only visits across multiple plan types, effective October 1, 2025 for Medicare Advantage. Audio-only visits are now covered for behavioral/mental health services and certain medical services, reimbursed at 80% of the standard in-person rate. Billing teams must verify patient plan type and apply correct reimbursement rates for audio-only telehealth claims.
HMSA · Identified Oct 4, 2026Medium impact
Required Documentation for Medical Respite Referrals
HMSA has issued new documentation requirements for providers referring members to the Medical Respite Program. All referrals must now include three specific completed forms (Medical Respite Authorization Form, CIS+ Member Consent Form, and Medical Respite Person-Centered Service Plan) before member admission. HMSA has created a fillable packet with a CIS+ program checklist to streamline submission of complete authorization requests.
HMSA · Identified Jun 20, 2026Medium impact
Hospice Care Payment Policy
HMSA has updated their Hospice Care Payment Policy with new guidance available in their provider resource center. This policy affects billing and payment procedures for hospice care services provided to HMSA members.
HMSA · Identified Jun 20, 2026Medium impact
Payment Policy Intravenous Therapy
HMSA has updated their Payment Policy for Intravenous Therapy. This is a very recent policy change that may affect billing procedures, coverage criteria, or reimbursement rates for IV therapy services.
HMSA · Identified Jun 20, 2026Medium impact
Payment Policy Chemotherapy Drugs And Services
HMSA has published a new payment policy specifically for chemotherapy drugs and services. This policy likely establishes coverage criteria, billing requirements, and reimbursement guidelines for oncology treatments and related medications.
HMSA · Identified Jun 20, 2026Medium impact
Mobile Clinic POS15 Payment Policy For E M Codes
HMSA has updated their payment policy for Evaluation and Management (E&M) codes when billed with Place of Service 15 (Mobile Clinic). This policy clarifies billing and reimbursement rules for healthcare services provided in mobile clinic settings.
HMSA · Identified Jun 20, 2026Medium impact
Pharmacy Non Specialty Drug Policies
HMSA has updated their Pharmacy Non Specialty Drug Policies. This policy change affects how non-specialty medications are covered and processed, but specific details require accessing the full policy document through the provider resource center.
HMSA · Identified Jun 20, 2026Medium impact
Medical Specialty Drug Policies D F Archived
HMSA has archived their Medical Specialty Drug Policies for categories D-F, meaning these policies are no longer active. This affects specialty drug coverage and prior authorization requirements for drugs in these categories.
HMSA · Identified Jun 20, 2026Medium impact
Policies With Updates Related to HMSA s Payment Policies
HMSA has published updates to their payment policies. This appears to be a notification about multiple policy changes affecting HMSA payment procedures, but specific details are not available in the summary provided.
HMSA · Identified Jun 20, 2026Medium impact
Pharmacy Specialty Drug Policies A G
HMSA has updated their pharmacy specialty drug policies for drugs A-G. This affects billing and coverage for specialty medications that require special handling, prior authorization, or step therapy requirements.
HMSA · Identified Jun 20, 2026Medium impact
Pharmacy Specialty Drug Policies H N
HMSA has updated their specialty drug policies covering medications beginning with letters H through N. This policy resource provides current coverage criteria, prior authorization requirements, and billing guidelines for specialty pharmaceuticals in this alphabetical range.

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

HealthPro News – October 2026

ACA Individual Network Change

Changes to ASAM 3.5 Residential Treatment Authorizations

New oncology prior authorization code updates

HealthPro News – November 2026

Medicaid: Paper submissions no longer accepted

Molecular Biomarkers for Prostate Cancer Risk Stratification - Medicare Advantage (Revised)

Bariatric Surgery - Medicare Advantage (Revised)

Spinal Fusion Surgery - Medicare Advantage (Revised)

Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)

Ambulatory Cardiac Monitoring Devices - Medicare Advantage (Revised)

Neuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)

Neuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)

Genetic Testing for Hereditary Cancer - Medicare Advantage (Revised)

Breast Reconstruction - Medicare Advantage (Revised)

Breast Excision and Mastectomy - Medicare Advantage (Revised)

Benign Prostatic Hyperplasia Treatments - Medicare Advantage (Revised)

Breast Imaging - Medicare Advantage (Revised)

Medicaid: Required documentation changes for hip and knee total joint replacements

Hawaii Medicaid: Get ready for paperless claim-related documents and submissions starting Oct. 3

Precertification Requirements

Claim Documentation Requirements

Provider Directory

Hereditary cancer testing policy reminder

Hawaii Medicaid: Updated payment policy for acute care readmissions

Suspension of Prior Authorization Reviews For Maui County

Prostate Cancer Detection with IsoPSA®

Neuroablative Techniques for Chronic Pain - Medicare Advantage (Revised)

Noninvasive Tests for Hepatic Fibrosis - Medicare Advantage (Revised)

Low Frequency, Noncontact, Nonthermal Ultrasound for Wound Care - Medicare Advantage (Revised)

New oncology prior authorization code update

Medicaid: New prior authorization codes for VBT and extremity prosthetics services

Molecular Diagnostic Assays and Breath Testing for Transplant Rejection - Medicare Advantage (Revised)

Liquid Biopsy - Medicare Advantage (Revised)

Coronary CT Angiography, Fractional Flow Reserve with CT and Adjunctive Testing - Medicare Advantage (Revised)

Medicaid: View new genetic and molecular code updates

Medicaid: Prior authorization required for certain transcatheter heart valve procedures

Advanced Imaging of the Head and Neck - Medicare Advantage (Revised)

AARP Medicare Supplement: Change to overpayment reimbursement process

Telehealth

Required Documentation for Medical Respite Referrals

Hospice Care Payment Policy

Payment Policy Intravenous Therapy

Payment Policy Chemotherapy Drugs And Services

Mobile Clinic POS15 Payment Policy For E M Codes

Pharmacy Non Specialty Drug Policies

Medical Specialty Drug Policies D F Archived

Policies With Updates Related to HMSA s Payment Policies

Pharmacy Specialty Drug Policies A G

Pharmacy Specialty Drug Policies H N