Hawaii Medical Service Association (HMSA)
Welcome to the HMSA (Hawai‘i Medical Service Association) page. Here you can access useful information about the program.
If you have questions about the programs, please contact HMSA or your dedicated Magellan Hawaii Provider Relations Manager, Laurie Kim.
Clinical Guidelines:
- Advanced Imaging and Cardiac Clinical Guidelines - Effective April 1 Annually
- Pain Management (IPM) Guidelines - Effective January 1 Annually
- Spine Surgery Guidelines - Effective January 1 Annually
- Hip, Knee Shoulder Guidelines - Effective January 1 Annually
Note: Refer to the Utilization Review Matrix documents to view specific codes managed by Magellan Healthcare
UM Matrix:
Advanced Imaging & Cardiac Solutions:
Interventional Pain Management & Surgery:
- HMSA IPM Utilization Review Matrix - 2022
- HMSA Spine Surgery Utilization Review Matrix - 2022
- HMSA Hip, Knee and Shoulder Utilization Review Matrix - 2022
Conservative Care:
- Member's Guide to Conservative Care plus Guide for Home Exercises
- Conservative Treatment Form - Imaging
- Conservative Treatment Form - Interventional Pain Management
- Conservative Treatment Form - Joints (Hip, Knee, Shoulder)
- Conservative Treatment Form - Back/Neck (Spine Surgery)
Helpful Educational Documents by Program:
- What to do when your request is denied or auth has expired
- HMSA's Dual Insurance Rules
- Peer to Peer Process
Advanced Imaging Program:
- HMSA Advanced Imaging Checklist
- HMSA Advanced Imaging Quick Reference Guide (QRG)
- HMSA Advanced Imaging Tip Sheets
- HMSA Advanced Imaging Tip Sheets for Pediatrics
- HMSA Preauthorization Process for Clinically Urgent Requests
- HMSA Clinical Fast Pass / Limited Fast Pass
Cardiac Solutions Program:
- HMSA CPT Catheterization Code Clarification
- HMSA Cardiac Solutions Checklist
- HMSA MPI vs Stress Echo Tip Sheet
- HMSA Cardiac Tip Sheet
- HMSA Cardiac Solutions Frequently Asked Questions (FAQs)
- HMSA Cardiac Solutions Quick Reference Guide (QRG)
- HMSA Preauthorization Process for Clinically Urgent Requests
Musculoskeletal Program (Pain Management, Spine, Hip, Knee & Shoulder Surgery) Program:
- Interventional Pain Management (IPM):
- Spine Surgery:
- Hip, Knee, Shoulder Surgery Program:
RadMD Documents
RadMD is a user-friendly, real-time tool offered by Magellan Healthcare that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by program:
Provider Training
- Advanced Imaging & Cardiac Program Provider Training
- Interventional Pain Management & Surgery Program Provider Training
- Hip, Knee, Shoulder Surgery Expansion Program Overview
Recorded General Trainings
We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.
Recorded RadMD Demos
Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.
Clinical Training Modules
We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.
Update on COVID-19
Click here to view our recommendations on the use of CT to detect Coronavirus (COVID-19).