HMSA Pacific Healthcare HMO

Contents

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

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.

PHC Out of Network Referral Form

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

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 10/2019A).
  • 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.