Resources For Providers

• Topics include:
  • About AlohaCare Plans and Services
  • Health Coordination Program and Model of Care
  • Prior Authorizations and Referral Information
  • Claims Guidelines and Claims Report Card
  • Grievance & Appeals
  • Fraud, Waste, and Abuse
  • Updated Provider Resources and Tools

 Click here to access the Provider Training (Part 2)

•  Topics include:
  • About AlohaCare and Provider Relations Support
  • Quality Program (P4P)
  • Value Based Payments (VBP)
  • Behavioral Health Program
  • Pharmacy Program (New PBM)
  • EVV Overview and Implementation
  • Provider Resources and Tools

After completing the provider training materials, please complete the training acknowledgement form by clicking 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.

• SNP Model of Care Summary
• 2020 SNP MOC Provider Training
• SNP Model of Care Training Acknowledgment

• 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.

1. Med-QUEST
2. Center for Medicare and Medcaid Services (CMS)
3. Noridian Medicare
4. National Committee for Quality Assurance (NCQA)

5. 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.