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.
[referral request form]
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.
Frequently Asked Questions
- Obtain authorization for a referral to an Out-of-Network (Non-PHC) provider within the State of Hawaii. Please note that out-of-state providers require a separate Administrative Review handled directly by HMSA.
- Claim re-processed for payment recovery without an approved referral form.
- Submit Referral form within 90 days prior to service date.
- Requested Information and/or documentation must be submitted to PQH within 7 business days.
Preferably the member’s PCP will submit the referral. However, any PMAG physician may submit a referral on behalf of PHC members.
Use ONLY the most updated Out-of-Network Referral Request Form (Revised 08/2016A).
- In-network specialties or services are not available within the Pacific Health Care network.
- There is a medical need to obtain services outside of the network.
- Fill out legibly and complete all required elements. Incomplete forms will not be processed.
- FAX to Partners for Quality Health at (808) 943-8732.
- Urgent and Stat requests require pertinent clinical reason.
In-network provider is available to provide service or product.
- Monday through Friday from 9 a.m. to 5 p.m.
- Closed on most major holidays. However, fax transmissions can be received at all hours of the day at 943-8732.