ALOHACARE ADVANTAGE PLUS (HMO SNP)

1. AC Online Registration : Sign up to access member eligibility, claim billing and prior authorization information.
2. Provider Complaint : File a complaint with AlohaCare about our services or our members.
3. Referral/Prior Authorization/Notification Request : Refer your patients to specialists or request authorization for services/procedures on the prior authorization list.
4. Drug Coverage Request : Request drug coverage for drugs that are not on the formulary, require authorization, have limitations or tier change.
5. Request for Addition/Deletion of Medicare to Formulary : Explain why drugs should be added or deleted from our formulary.
6. Medicare Part D Coverage Determination Request : Request an authorization or an exemption to our formulary.
7. Request for Taxpayer Identification Number and Certification (W-9 Form): Fill out the W-9 Form for our files. We’re required to have your taxpayer identification number and certification on record.
8. Notification of Termination of Behavioral Health Treatment: For Behavioral Health Providers Only: Complete this form when terminating outpatient professional services, or chemical dependency treatment.
9. Outpatient Psychological Testing Request: For Behavioral Health Providers Only. Complete this form to request outpatient professional psychological or neuropsychological testing.
10. Newly Updated! Behavioral Health Outpatient and/or Chemical Dependency Interval Treatment Plan: For Behavioral Health Providers only. Complete this form when more than 10 hours of outpatient professional sessions or continuing chemical dependency services are needed. 
11. Begin the process of joining AlohaCare’s Provider Network by completing the appropriate provider profile.

          Behavior Health Provider Profile Form 
          Facility & Ancillary Provider Profile Form 
          Physician’s Assistant Provider Profile Form 
          Primary Care Provider Profile Form 
          Specialist Provider Profile Form