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Human Services Hawaii.gov

Be a New Provider

Find the information and application process to become a new health or dental provider below.

Be a New Provider

HOKU Website Links:

Providers may access HOKU as follows:

*Please create your HOKU username and password prior to clicking on the 'Logon to HOKU' link.  Click here for instructions on how to setup your HOKU account and create your username and password.

New providers are required to enroll as a Medicaid provider using HOKU (links above).

The Med-QUEST Division will also accept new provider applications or existing provider change requests by email, fax or mail.
Email: [email protected]  
Fax: 808-692-8087
Mailing Address:
 Med-QUEST Division
Health Care Services Branch, Provider Enrollment
601 Kamokila Blvd., Room 506A
Kapolei, Hawaii 96707

Med-QUEST Division is doing our part to help prevent the spread of COVID-19 while continuing our services. We encourage providers to avoid coming to our office and to utlize the three options above (email, fax and mail).  If you prefer or are only able to drop off your app, a drop box is available in the lobby of our building to drop-off provider applications or change request forms.  Please use the bin that says ‘Medicaid Provider Drop-off Bin.’

 

Note:  DHS 1139 Attachments (DHS 1139A to DHS 1139F) are included in the revised DHS 1139 form above.

  • Appendix L: DHS 1139A - Psychiatry/Psychology Credentialing Attachment
  • Appendix M: DHS 1139B - Non-Emergency Ground Transportation-Taxi Cabs Attachment
  • Appendix N: DHS 1139C - Home Health Services Attachment
  • Appendix O: DHS 1139D - Acute Hospital Attachment
  • Appendix P: DHS 1139E - Nursing Facility Attachment
  • Appendix Q: DHS 1139F - Intermediate Care Facility for The Developmentally Disabled/Intellectually Disabled Individuals (ICF-DD/ID) Attachment

Contact Information:

Email: [email protected]  
Phone:   1-833-909-3630
Fax: 808-692-8087
Mailing Address:
 Med-QUEST Division
Health Care Services Branch, Provider Enrollment
601 Kamokila Blvd., Room 506A
Kapolei, Hawaii 96707

HOKU Website Links:

Providers may access HOKU as follows:

*Please create your HOKU username and password prior to clicking on the 'Logon to HOKU' link.  Click here for instructions on how to setup your HOKU account and create your username and password.

Dental Application

Currently, all dental services are provided under the fee-for-service program, which covers dental services for Hawaii Medicaid recipients. (Previously dental services were part of the managed care program.) If you would like to be a dental provider or if you are already a provider and want to report changes you can use the HOKU website link above or fill out the revised Provider Enrollment Application (DHS 1139 Rev 11/2022).

New Applicants:

You should enroll in HOKU or submit a new paper application if you:

  • Opened a new private practice
  • Were a Managed Care Provider
  • Are reactivating a Medicaid Provider number which was terminated more than one year ago.
  • If you are establishing a payee (pay to) other than your own social security number . A separate application must be submitted on behalf of the payee entity (e.g. XYZ, Inc or LLC).

Current Applicants:

To modify information on existing Applications, do so by logging-in to HOKU.  If you choose to submit a paper application, please fill out the revised Provider Enrollment Application (DHS 1139 Rev 11/2022).

You should submit an application if you need to:

  • Add a location
  • Close a location
  • Change ownership
  • Make any other adjustments on your existing application:

Please refer to the "Required and Optional Licenses, Certificate and Documents by Provider Type” for additional information that you may be required to upload in HOKU or submit with your paper application (i.e. current Hawaii license, W-9, Federal DEA, etc.) Click on the 'Resouces' tab.

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