Hawaii Medical Billing: Medicare, Medicaid, and Auto Injury Claims
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Full transcript
Overview
For Hawaii practices, medical billing needs special attention to payer sequencing because the state has details that change how claims are handled.
Medicare contractor
Medicare claims are adjudicated by Noridian Healthcare Solutions JE, and that contractor path also matters for the first level of Medicare appeal.
Medicaid program
Medicaid runs through MedQuest and is delivered largely through commercial managed care plans. So many Medicaid claims go to a health plan rather than directly to the state.
Auto injuries
Hawaii is a no-fault/PIP state for auto injuries, which means the auto carrier is the payer of first resort instead of the health plan. Billing the health plan first can create a denial that looks like a coverage problem, but the real issue is sequencing.
Coding, claims, and follow-up
WGMB supports Hawaii practices with certified coding, claim scrubbing and submission, rejection follow-up, denial management, payment posting, accounts receivable auto injury sequencing, patient statements, payment plans, and billing support.
The takeaway
For Hawaii practices, the goal is to keep the payer order clear so claims move through the right path the first time
What is different about billing in Hawaii?
- Medicare contractor
- Noridian Healthcare Solutions (JE)
- Medicaid program
- Med-QUEST
- Medicaid delivery
- Commercial managed care plans
- Auto injuries
- No-fault: the auto carrier pays first
Want your Hawaii claims worked for you?
We code, submit, and follow up on claims for Hawaii practices, with Medicare appeals worked to Noridian (JE) and Medicaid billed to Med-QUEST. Tell us about your practice and we'll send a written scope and price.
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White Glove Medical Billing is a medical billing, coding, and revenue cycle company — not a healthcare provider and not a law firm. All coding is performed by certified coders from your providers' documentation; the clinical record and the certification of medical necessity remain the provider's.