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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.
Please note the important updates:
- Allow a maximum of seven (7) business days to process requests
- Non-Urgent, Urgent, and STAT check boxes have been added to the form. Please specify clinically pertinent reasons before expediting any requests.
Updates to Pacific Health Care Out-of-Network Referral Management
We’ve added more details to our Frequently Asked Questions (FAQs) page. Please see our Frequently Asked Questions section below for the updated information.
We are happy to announce that Out Of Network referral requests can now be securely submitted online using the button below. We will still accept faxed referrals but encourage electronic submission. For the most updated OON referral form, please use the buttons below.
Frequently Asked Questions
Pacific Health Care (PHC) Out-of-Network Referral Request
- Pacific Health Care patients require authorization to see an out-of-network provider (NON PHC). To determine if the provider is out-of-network, search the PMAG directory at https://www.pmaghawaii.org/directory/. You may also call our Referral Coordinator at 808-953-2504.
- Claims will be reprocessed for payment recovery without an approved referral.
- Be sure to provide a detailed reason for referring out-of-network.
- In network service or product is not available by a PHC provider.
- There is a medical need to obtain outside of the network.
- Referral should be submitted within 90 days prior to service date.
- Preferably the PCP, but any PMAG physician may submit a referral.
- ONLY PMAG physicians and their staff are authorized to sign and submit referrals.
- Be sure to provide staff contact information should PMAG need additional information.
- ELECTRONIC: Secure online submission
- FAX: 808-943-8732
- Download the form on the PMAG website
- Fill out legibly and complete all required elements.
- Incomplete forms will not be processed.
- Urgent and Stat requests require pertinent clinical reason. Appointments and scheduling are not considered clinical reasons and will be reviewed as Non-urgent
- Processing Time:
- Stat – 24 hours
- Urgent – 3 business days
- Non-Urgent – 5 to 7 business days
- Monday – Friday, 9:00am to 5:00pm.
- Closed on most state and major holidays.
- Submission online or by fax accessible 24 hours.
Contact
For PHC Out-of-Network Referral Inquiries
Contact Referral Management
Phone: (808) 953-2506
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
