Hawaii
Medical Billing Services in Hawaii
For Hawaii practices: insurance billing at 4-8% of collections, credentialing, and no long-term contract. HMSA, Med-QUEST and TRICARE billing on every island.
Key takeaways
- 01The Prepaid Health Care Act requires employers to cover employees working 20 or more hours a week.
- 02Med-QUEST runs through five plans: AlohaCare, HMSA, Kaiser Permanente, 'Ohana Health Plan and UnitedHealthcare Community Plan. The current contracts run to 31 December 2026.
- 03Hawaii requires clean claims paid within 15 days if filed electronically and 30 days on paper, with 15% annual interest (HRS 431:13-108).
Why Providers in Hawaii Partner With Us
Hawaii Payer Billing
Med-QUEST and commercial claims, each sent the way that payer requires
Coders Matched to Your Specialty
Your claims are coded by people who work in your specialty every day
Dedicated Account Manager
Someone who knows your practice, your payers and your open claims
No Long-Term Contract
You keep the option to leave: no long-term contract, and billing at 4-8% of collections
What Medical Groups in Hawaii Get From Our Billing
Hawaii Payer Billing. Billing for HMSA, the Med-QUEST plans and Hawaii's employer-sponsored plans
HIPAA Compliant. A dedicated account manager for each practice, working under HIPAA compliant procedures
See How Much Revenue Your Hawaii Practice Is Leaving on the Table
Get a free, no-obligation practice assessment. We'll analyze your claims, denials, and A/R to show you exactly where you're losing money.
Billing Support Throughout Hawaii, Region by Region
Oahu: Honolulu & Urban Core
Honolulu is Hawaii's largest healthcare market, home to The Queen's Medical Center, Hawaii Pacific Health and Straub Medical Center. The Prepaid Health Care Act means most working patients carry employer coverage.
HMSA, the state's Blue Cross Blue Shield plan, is one of the payers whose plan rules and billing requirements Oahu practices deal with daily.
Cardiology / oncology / orthopedics / primary care / gastroenterology
Maui & Neighbor Islands
Maui Health System, Hilo Medical Center and Kauai Veterans Memorial Hospital serve small, isolated island populations. Referrals to Oahu or the mainland for specialty care bring inter-island air transport and cross-facility coordination into billing.
Rural and critical access hospital billing rules apply to many neighbor island facilities, and telehealth helps bridge gaps in specialist access.
Family medicine / emergency medicine / OB/GYN / rural health / telemedicine
Kona & West Hawaii (Hawaii Island)
The Kona coast serves resort and retiree communities and many international visitors. Kona Community Hospital serves the west side of the island, and patients needing tertiary care travel to Hilo or fly to Oahu.
International visitors may not carry US insurance, so self-pay billing and international insurance claims are part of the work.
Emergency medicine / primary care / orthopedics / geriatrics / urgent care
What Practices Ask About Medical Billing in Hawaii
The Prepaid Health Care Act requires employers to cover employees who work 20 or more hours a week. Practices see a wide range of employer-sponsored plans, each with its own billing requirements.
Med-QUEST runs through five plans: AlohaCare, HMSA, Kaiser Permanente, 'Ohana Health Plan and UnitedHealthcare Community Plan. HMSA's Med-QUEST plan needs its own credentialing, separate from HMSA commercial, and the current plan contracts run to 31 December 2026, so check for 2027 changes.
Inter-island referrals, air transport and a separate HMSA Med-QUEST enrollment all add steps. Schofield Barracks, Pearl Harbor and Hickam also bring TRICARE claims to many practices.
HRS 431:13-108 requires clean claims to be paid within 15 days if filed electronically and 30 days if filed on paper. Late payments carry 15% annual interest.
Hawaii patients are protected by the federal No Surprises Act, in effect since January 2022. It bars balance billing for most emergency care and for out-of-network care at in-network facilities.
Under 42 CFR 424.44, a Medicare claim must be filed within 12 months of the service date. Each commercial plan and Medicaid health plan sets its filing window in its own contract, so the deadline has to be read from that contract.
The Billing We Run for Hawaii Providers
From eligibility checks to final payment, we handle your billing so you can focus on patients.
Claims Management. Claim submission and follow-up until each claim is paid or closed
Denial Management. Denied claims worked and appealed
Patient Billing. Clear patient statements and payment plans
Credentialing. Payer enrollment at $150 per application, per provider, usually 60 to 90 days with each payer, in our experience
Want a Second Look at Your Billing?
Get a free, no-obligation review of your practice's billing.
- Where claims are being denied, and why
- Which unpaid claims can still be recovered
- What billing would cost at 4-8% of collections
Specialties We Support Across Hawaii
We are a specialist biller for mental health, behavioral health and therapy, and other specialties are welcome.
- Behavioral Health
- Mental Health
- Occupational Therapy
- ABA Therapy
- Substance Use Treatment
- Psychology
- Speech Therapy
- Psychiatry
- Physical Therapy
- Primary Care
- Internal Medicine
- OB/GYN
- Orthopedics
Bring Medtransic to Hawaii's Independent Providers
Let us handle your medical billing so you can focus on patient care