Pacific Health Care

Contents

Referral Request Form

What is Pacific Health Care?

Pacific Health Care (PHC) is a health center under the Health Maintenance Organization (HMO), Health Plan Hawaii (HPH), offered by the Hawaii Medical Services Association (HMSA). PMAG is the independent physician association that comprises the Pacific Health Care network of doctors. All PMAG physicians are participating providers within the Pacific Health Care network.

Out-of-Network Referral Management

Partners for Quality Health (PQH), a management services organization, continues to process PMAG’s out-of-network referral requests. PQH’s goal is to process referrals in a timely manner that will not compromise care for PHC members.

Updates to Pacific Health Care Out-of-Network Referral Management

A simplified version of the Out-of-Network Referral Request Form for PHC has been recently updated. Going forward, all out-of-network requests will need to be made using this form.

Referral Request Form

Please note the important updates:

Contact

For PHC Out-of-Network Referral Inquiries

Contact Referral Management

Phone: (808) 942-1852

For HMSA Member Inquiries

Contact HMSA Customer Relations

Phone: (808) 948-6372

For Out-of-State Provider Inquiries, HMO Administrative Review and Precertification Request

Contact HMSA Medical Management

Phone: (808) 948-6464

HMSA Provider Services

Phone: (808) 948-6330

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Frequently Asked Questions

Why submit a Referral?

When to submit a Referral?

Who submits a Referral?

What form to use?

When to go outside of the network?

How to submit?

Criteria for “NOT APPROVED” Requests:

PQH Hours:

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