Resources For Providers

We want to make sure that you have additional resources to take care of our members. Below is a list of resources and links that you may find helpful.

Provider Training

AlohaCare Provider Training Webinars 2023

August 2023
July 2023
May 2023
April 2023:
- Topics Include:
  - 2023 Quality Incentive Program Goals
  - Medicaid Pay for Performance Measures
  - Medicare Pay for Performance Measures
  - AlohaCare Quality Support Programs
  - Med-QUEST -- QUEST Integration Medicaid Member Redetermination
February 2023:
- Topics Include:
  - Med-QUEST -- QUEST Integration Medicaid Member Redetermination
  - Med-QUEST Provider Registration via HOKU
  - Prior Authorizations (Medical, Non-Emergency Medical Transportation, Referrals)
  - AlohaCare Advantage Plus, Medicare D-SNP Model of Care
  - 2023 Medicare STARS Updates

AlohaCare Provider Training Webinars 2021 and 2022

[Click here to access the training.]

We encourage you and your staff to review our training materials and complete the training acknowledgement form (click here), and fax it to Provider Relations unit at 808-973-0811. If you would like to request in-person or remote training, please call Provider Relations at 808-973-1650 or toll-free at 1-800-434-1002.

Mahalo for your participation and continued support to our members!

Cultural Competency

Provider Cultural Competency Program
- CCP Provider Acknowledgment Form
- Note: AlohaCare encourages you and your staff to review our training materials and complete the training acknowledgment form. Mahalo for your participation and continued support to our members!
Other resources

AlohaCare Advantage Plus (HMO SNP) Model of Care Program

AlohaCare Advantage Plus is a dual-eligible Special Needs Plan (SNP). One advantage for members of SNP plans is the SNP Model of Care, which is an interdisciplinary care coordination program.

The following are links to resources related to the SNP Model of Care.

AlohaCare Credentialing and Recredentialing Process

Click here for more information about AlohaCare's credentialing process.

AlohaCare Electronic Claims Submission – EDI Partners

Benefits of Submitting Claims Electronically via EDI:

Expedite claims processing and payment.
Decrease administrative, postage and supplies costs.
Provides rapid notification of claims receipt and status.

Click here for more information about how to submit claims electronically.

• Gateway also known as Trizetto

Phone Number: 800-969-3666

www.GatewayEdi.com

• Legacy also known as Hawaii X-Change & Administep

Phone Number: 888-751-3271 ext. 3127

https://administep.com/

Note: Office Ally submits claims via this clearing house vendor.

• Change Health

Phone Number: 866-817-3813

www.ChangeHealthcare.com

• Waystar also known as ClaimRemedi & eSolutions

Phone Number: 877-635-2920

https://www.waystar.com

• NextGen

Phone Number: 1-800-426-3385

www.nextgen.com

**Providers, Practices and Facilities that have delegated their claims submissions for AlohaCare to a Physician Billing or Practice Management Services Company may work with our clearing house partners to establish EDI claims submission capabilities for AlohaCare.

AlohaCare Electronic Funds Transfer & Remittance Advice (Payspan)

Information about Payspan

Contact PaySpan:

1-877-331-7154, Option #1
Hours of Operation - 2:00 a.m. HST through 2:00 p.m. HST
E-mail Payspan Support: Providersupport@Payspanhealth.com

Vaccine Hesitancy Training

CME Eligible Vaccine Hesitancy Training Now Available

In collaboration with Hawaii MQD and the Centene Institute for Advanced Health Education®, all MedQUEST Health Plans are pleased to offer providers with a new CME eligible training: “Vaccine Hesitancy: How to Identify and Approach the “Movable Middle”.

This course will provide education for primary care providers in addressing vaccine hesitancy in order to increase rates of COVID-19 and other vaccinations. Other practical topics discussed include COVID-19 misinformation (such as infertility/reproduction and myocarditis) and information on becoming a COVID-19 vaccine provider.

At the close of this activity, participants will be able to more comfortably discuss barriers to vaccine uptake and patient misconceptions and misinformation about vaccinations for COVID-19. Additionally, participants will learn multiple strategies to promote vaccinations for a variety of diseases and to implement motivational interviewing and other evidence-based communication tools to promote vaccinations. The program also addresses cultural considerations for special populations with whom you may work.

Registration: This course is accessible through www.centeneinstitute.com. Once you have registered as a new user, navigate to the Activity Catalog. In the Activity Catalog, search for the course title and register by clicking on ENROLL NOW.

An overview of the course, including information on continuing education credit available for physicians and nurses, can be found at: https://www.centeneinstitute.com/activities/618aded5ae0a950008002d34/overview.

For any questions on the course or enrollment process, please contact the Centene Institute for Advanced Health Education® at Centene_Institute@centene.com.

National Plan and Provider Enumeration System (NPPES)

The National Plan and Provider Enumeration System (NPPES) serves as the national system designed to assign unique identifiers to health care providers and health plans who apply for the National Provider Identifier (NPI).

Please take the time to review your NPI data in NPPES as soon as possible to ensure that accurate provider data is displayed. As you may know, providers are legally required to keep their NPPES data current. Centers for Medicare & Medicaid Services (CMS) is also encouraging Medicare Advantage Organizations to use NPPES as a resource for our online provider directories. By using NPPES, we can decrease the frequency by which we contact you for updated directory information and provide more reliable information to Medicare beneficiaries.

If the NPPES database is kept up to date by providers, AlohaCare can rely on it as a primary data resource for our provider directories, instead of calling your office for this information. With updated information, we can download the NPPES database and compare the provider data to the information in our existing provider directory to verify its accuracy.

When reviewing your provider data in NPPES, please update any inaccurate information in modifiable fields including provider name, mailing address, telephone and fax numbers, and specialty, to name a few. You should also make sure to include all addresses where you practice and actively see patients and where a patient can call and make an appointment. Do not include addresses where you could see a patient, but do not actively practice. Please remove any practice locations that are no longer in use. Once you update your information, you will need to confirm it is accurate by certifying it in NPPES. Remember, NPPES has no bearing on billing Medicare Fee-For-Service.

If you have any questions pertaining to NPPES, you may reference NPPES help at https://nppes.cms.hhs.gov/webhelp/nppeshelp/NPPES%20FAQS.html#

For more information about NPI and how to obtain an NPI, please visit the NPPES website. Visit the NPPES website

Additional Resources

Below is a list of resources that you may find helpful. By clicking on any of the links below, you will be leaving the AlohaCare website.

Med-QUEST
Center for Medicare and Medcaid Services (CMS)
Noridian Medicare
National Committee for Quality Assurance (NCQA)
Urgent Care - Urgent care services can be accessed when a member is experiencing an illness or injury that requires urgent attention that cannot be delayed when a member’s Primary Care Provider (PCP) or health center is not accessible during normal business hours or when after hour care is needed. Click here for a list of participating Urgent Care Clinics and Community Health Centers with extended hours.