Provider Memos

View the current memos below:

The following files are available for download. You will need Adobe Acrobat Reader to view these files. For later memos, see Pharmacy Communications.

QI Memos - 2022

  • QI-2221- Managed Care Organization (MCO) Pay for Performance Guidance for Measurement Year 2023 and                Measurement Year 2026 
  • QI-2220A - (Replaces QI-2220) - Managed Care Organization Pay for Performance Guidance for Measurement Years                        2021 and 2022
  • QI-2220 - (Replaced by QI-2220A) - Managed Care Organization Pay for Performance Guidance for Measurement                           Years 2021 and 2022
  • QI-2219 - Quest Integration (QI) Transition of Care (TOC FILES)
  • QI-2218 - Payment Suspension to Provider - Michael Izumi, DDS
  • QI-2217 - RESCINDED Payment Suspension to Provider - Jennifer Grace Shaw, LMHC (Replaces QI-1606)
  • QI-2216-  Health Functional Assessment (HFA) Cohort Approach Pilot 
  • QI-2215 - Medicaid Fee-For-Service and Quest Integration Hospice Rates Effective October 1, 2022 through
                    September 30, 2023
  • QI-2214-  Change in Reprocessing Pended EVV Encounters 
  • QI-2213 -  (Replaces QI-1715) - Clarification of reporting requirements for medications provided by 340B contract                             pharmacies to QUEST Integration (QI) and Community Care Services (CCS) Members
  • QI-2211 -  APR DRG Billing Guidance 
  • QI-2210 - Medicaid Fee-For-Serviice Rates - Effective July 1, 2022
  • QI-2209 - Medicaid Fee-For-Service Hospice Nursing Facilitiies Rates - Effective July 1, 2022 - December 31, 2022
  • QI-2208 - Med-QUEST Guidance on Medicaid Coverage of Routine Patient Costs Furnished in Connection with                 Participation in Qualifying Clinical Trials (Replaces QI-2150)
  • QI-2207- Auto Assigment Algorithm for Quest Integration (QI) Members - Effective July 1, 2022 - December 31, 2026
  • QI-2206- APR DRG Billing Guidance (Update to QI-2116A)
  • QI-2205 Requirements for Health Plans to Submit NDC Code and NCPDP Units on Encounters 
  • QI-2204A- COVID-19 Home Test Kits (NON-PCR) (Replaces QI-2204)
  • QI-2204- (Replaced by QI-2204A) - COVID-19 Home Test Kits (NON-PCR)
  • QI-2203- Requirement for Health Plans to Submit the CN1 Segment on Encounters (Replaces QI-2124)
  • QI-2202- Emergency Transportation to Alternative Destinations
  • QI-2201 - Medicaid Fee-For-Service Hospice Nursing Facilities Rates - Effective January 1, 2022 - June 30, 2022

 

QI Memos - 2021

  • QI-2167 - Community Care Foster Family Home (CCFFC) and Expanded Adult Residential Care Home (EARCH) Rates                  for Home and Community Based Services (HCBS) Effective January 1, 2022
  • QI-2166 - Medicaid Fee-For-Service Rates - Effective January 1, 2022 - June 30, 2022
  • QI-2165 - Medicaid Fee-For-Service FQHC & RHC PPS Rates - Effective January 1, 2022 - December 31, 2022
  • QI-2164 - Hawaii Medicaid EPSDT Update
  • QI-2163 - Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Data Requirements for Health Plans
  • QI-2162 - QUEST Integration (QI) Transition of Care (TOC) Files
  • QI-2150 - (Replaced by QI-2208) - MED-QUEST Guidance Regarding the Coverage of Routine Costs Associated with                    Qualifying Clinical Trials (Replaces QI-1934) 
  • QI-2149 - QUEST Integration Coverage for Our Care, Our Choice Act (End of Life Care Option) (Replaces QI-1927) 
  • QI-2148 - Support ACT MED-QUEST Division Minimum Standards Effective October 1, 2019 (Replaces QI-1926) 
  • QI-2147 - Guidelines and Procedures for Transportation, Meals, and Lodging Associated with Approved Inter-Island and                  Out-of-State Medical Services (Replaces QI-1921) 
  • QI-2146 - Primary Care Physicians (PCP) Managed Care Enhanced Reimbursement (Replaces QI-1918)
  • QI-2145 - Revised Grievances and Appeals Templates (Replaces QI-1909) (Attachments)
  • QI-2144 - Coordination of Services Between QUEST Integration and the 1915(c) Home and Community                                            Based-Services Waiver for a Member Under the Age of Twenty-One (21) with Intellectual and/or                                        Developmental Disabilities (Replaces QI-1821) 
  • QI-2143A - Payment Suspension Lifted - PAC MED
  • QI-2143 - Payment Suspension to Provider - Effective July 23, 2018 (Replaces QI-1812A)
  • QI-2142 - Health Plan Submission File Changes (Replaces QI-1806) (Attachment AA Master Record)
  • QI-2141 - Transition of Care - Clarification of Financial Responsiblity Roles (Replaces QI-1714)
  • QI-2140 - Medicaid Fee-For-Service (FFS) Dental Progam Dental Formulary (Replaces QI-1705) 
  • QI-2139 - Tele-Health Law (Act 226, SLH 2016) Implementation (Replaces QI-1702A)
  • QI-2138 - QI Health Plan and DOHEIP Collaboration (Replaces QI-1620) (Attachment A) (Attachment B
  • QI-2137 - Pregnancy Intention Screening and Contraceptive Coverage (Replaces QI-1613)
  • QI-2136 - Universal Precautions for QUEST Integration Members Receiving At-Risk and Home and Community Based                    Services (HCBS) (Replaces QI-1507) 
  • QI-2135 - Revised Instuctions to CMS-416 Report (Replaces QI-1426) 
  • QI-2134 - Home and Community Based Services Policy Guidance for Environmental Accessiblity Adaptations/Home                        Modifications, Moving Assistance and Specialized Medical Equipment and Supplies (Replaces QI-1420)
  • QI-2133 - Member Expedited Appeal Procedures (Replaces QI-1416A)
  • QI-2132 - At Risk for Institutional Level of Care Criteria (Replaces QI-1406)
  • QI-2131 - Supervision Requirements for Behavioral Health Providers in FQHCs and RHCs (Replaces ADM-1201)
  • QI-2130 - Elective Caesarean Section - Not Covered (Replaces BEN-1101) 
  • QI-2129 - Medicaid Fee-For-Service and Quest Integration Hospice Rates effective October 1, 2021 - September 30,                      2022
  • QI-2128 - Updated Guidelines for Health Coordination Assessments and Health Action Plans for Members Living in a                      Community Care Foster Family Homes (CCFFH), Expanded Adult Residential Care Homes (EARCH) and                        Assisted living Facilities (ALF)
  • QI-2127 - Auto Assignment Algorithm for QUEST Integration (QI) Members effective January 1, 2022 - December 31,                      2022
  • QI-2126A - COVID-19 Monoclonal Antibody Treatment - FQHC/RHC Reimbursement for Administration
  • QI-2126 - COVID-19 Monoclonal Antibody Treatment - FQHC/RHC Reimbursement for Administration
  • QI-2125 - Home Care Agency Providers of Home and Community Based Services 1915(c) Intellectual and                                        Developmental Disabilities (I/DD) Waver Providers 
  • QI-2125 - Home Care Agency Providers of Home and Community Based Services 1915(c) Intellectual and                                        Developmental Disabilities (I/DD) Waver Providers (ATTACHMENT)
  • QI-2124 - (Replaced by QI-2203) - Requirement for Health Plans to Submit the CN1 Segment on Encounters
  • QI-2123 - Covid-19 Pandemic Action Plan for QI Health Plans - Part VII
  • QI-2121 - Requirement for Providers to Register with Hoku
  • QI-2120 - Continued Coverage of Audio-Only Visits Through Federal Public Health Emergency (PHE)
  • QI-2119 - Medicaid Provider Enrollment for Personal Care Service Agencies and Home Health Care Agencies under the                  21st Century Cures Act 
  • QI-2118 - Provider Master Registry (PMR) File and Provider Type
  • QI-2117 - Mandatory Pickup/Dropoff Locations for Non-Emergency Transportation (ATTACHMENT)
  • QI-2117 - Mandatory Pickup/Dropoff Locations for Non-Emergency Transportation 
  • QI-2116A - (Updated by QI-2206) - Implementation of all Patients Refined Diagnosis Related Groups (APR DRG)
  • QI-2116 - Implementation of all Patients Refined Diagnosis Related Groups (APR DRG)
  • QI-2115 - Auto Assignment Algorithm for Quest Integration (QI) Members effective July 1, 2021 - December 31 2021 
  • QI-2114 - Subacute Definitions (Replaces QI-2024)
  • QI-2113B - Medicald Fee-For-Service Rates effective July 1, 2021 (Addendum to QI-2113A)
  • QI-2113A - Medicaid Fee-For-Service Rates effective July 1, 2021 (Addendum to QI-2113)
  • QI-2113 - Medicaid Fee-For-Service Rates effective July 1, 2021
  • QI-2112 - Medicaid Fee-For-Service Hospice Nursing Facilities Rates effective July 1, 2021 - December 31, 2021
  • QI-2111 - Community Integration Services (CIS) Rapid Cycle Assessments (RCAs)
  • QI-2109 - Hospice for Members Receiving Home and Community Based Services (HCBS)
  • QI-2108A - Payment Suspension to Providers (Hawaii Dental Clinic) (Addendum to QI-2108)
  • QI-2108 - Payment Suspension to Providers (Hawaii Dental Clinic)
  • QI-2107A - Covid-19 Pandemic Action Plan for QI Health Plans - Part VI (Addendum to QI-2107)
  • QI-2107 - Covid-19 Pandemic Action Plan for QI Health Plans - Part VI
  • QI-2106 - Medicaid Rural Health Clinic Prospective Payment System Dental Rates for Kahuku Medical Center -                              Effective October 12, 2020 through December 31, 2021
  • QI-2105 - Community Integration Services (CIS) Implementation Guidelines: Overview, Member Eligibility, Service                            Delivery, Coordination & Reimbursement
  • QI-2104A - CCFFH and EARCH Rates for HCBS (Addendum to QI-2104)
  • QI-2104 - Community Care Foster Family Home and Expanded Adult Residential Care Home Rates for Home and                          Community Based Services Effective January 1, 2021
  • QI-2103 - Medicaid Eligibility for Freely Associated States Under the Compact of Free Association (COFA) Citizens
  • QI-2102 - Civil Rights Awareness Training Requirements

 

QI Memos - 2020
  • QI-2042 - Medicaid Fee-For-Service Federally Qualified Health Center (FQHC) & Rural Health Clinic (RHC) Prospective                  Payment System (PPS) Rates - Effective January 1, 2021 through December 31, 2021
  • QI-2041 - Medicaid Fee-For-Service Rates - Effective January 1, 2021 (Addendum to QI-2022)
  • QI-2040 - Medicaid Fee-For-Service Hospice Nursing Facility Rates for Hospice Hilo dba Hawaii Care Choices and St.                    Francis Hospice - Effective January 1, 2021
  • QI-2039 - Dental Services Requiring General Anesthesia Performed in a Hospital Setting
  • QI-2038 - Orally Administered Drugs to Terminate a Pregnancy During the Public Health Emergency
  • QI-2037A - COVID-19 Pandemic Action Plan for QI Health Plans - Part V (Addendum)
  • QI-2037 - COVID-19 Pandemic Action Plan for QI Health Plans - Part V
  • QI-2036 - Telehealth Guidance During the Public Health Emergency related to EPSDT Visits
  • QI-2035 - Suspension to Provider (Paul A. Kaiwi Jr.)
  • QI-2033 - COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the                      Uninsured
  • QI-2032 - Medicaid Fee-For-Service Hospice Rates - Effective Octobr 1, 2020 through September 30, 2021
  • QI-2031 - QUEST Integration (QI) Transition of Care (TOC) Files
  • QI-2030 - Medicaid Fee-For-Service Hospice Nursing Facilities Rates - Effective July 1, 2020 
  • QI-2029 - HOKU COVID-19 Waivers and Policy Reminders
  • QI-2028 - Clarification on Applied Behavior Analysis (ABA) Services Through Telehealth
  • QI-2027 - Required Quantity Prescribed Field in Point of Sale Claim Submission for Schedule II Drugs
  • QI-2026 - Medicaid Rates for Legacy Hilo Rehabilitation and Nursing Center
  • QI-2025 - Universal Precautions for QUEST Integration Members Receiving At-Risk and Home and Community Based                    Services (Addendum to FFS-M15-05)
  • QI-2024 - Subacute Definitions (Replaces QI-2012, QI-2012A)
  • QI-2023 - Medicaid Rates for Island Skilled Nursing and Rehabilitation
  • QI-2022 - Medicaid Fee-For-Service Rates - Effective July 1, 2020
  • QI-2021 - Guidance on SARS-COV-2 Antibody Testing
  • QI-2020 - Coverage of Services for Autism Spectrum Disorder via Telehealth
  • QI-2019 - Updated DHS 1145 - Hysterectomy Acknowledgement Form and Rescinding 1146 - Sterilization - Consent                        Form Change
  • QI-2018 - Quality Portion of Auto-Assigment Algorithm for QUEST Integration (QI) Members
  • QI-2016 - COVID-19 Pandemic Action Plan for QI Health Plans and Providers - Part IV
  • QI-2015 - COVID-19 Pandemic Action Plan for QI Health Plans - Part III
  • QI-2014 - COVID-19 Pandemic Action Plan for QI Health Plans - Part II
  • QI-2013 - Telehealth Guidance for Public Health Emergency - Telephonic Services and Services Billable by Qualified                      Non-Physician Health Care Professionals
  • QI-2012A - (Replaced by QI-2024) - Subacute Definitions (Addendum)
  • QI-2012 - (Replaced by QI-2024) - Subacute Definitions
  • QI-2011A - Clarification of Items and Services Carved Out from the Long Term Care PPS Rates (Addendum)
  • QI-2011 - Clarification of Items and Services Carved Out from the Long Term Care PPS Rates    
  • QI-2010 - Telehealth Guidance During Public Health Emergency Related to COVID-19
  • QI-2009 - COVID-19 Pandemic Action Plan for QI Health Plans
  • QI-2008 - Federally Qualified Health Center Telehealth Guidance During Public Health Emergency Period in Response                    to COVID-19
  • QI-2007 - Tele-Health Payment Guidance for Federally Qualified Health Centers (FQHC)
  • QI-2006B - New Provider Enrollment System - HOKU System Update (Addendum)
  • QI-2006A - New Provider Enrollment System - HOKU System Update (Addendum)
  • QI-2006 - New Provider Enrollment System - HOKU System Update
  • QI-2005 - New State Medicaid ID Card Design
  • QI-2004 - Revised QUEST Integration Coverage for Our Care, Our Choice Act (End of Life Care Option)
  • QI-2003 - Community Integration Services (CIS) Data Requirements
  • QI-2002 - Payment Suspension to Provider (Philip Suh, MD) - Effective January 17, 2020

 

QI Memos – 2019
  • QI-1934 - (Replaced by QI-2150) - Med-QUEST Guidance Regarding the Coverage of Routine Costs Associated with                      Qualifying Clinical Trials
  • QI-1933 - Medicaid Fee-for-Service Federally Qualified Health Center (FQHC) & Rural Health Clinic (RHC) Prospective                  Payment Rates (PPS) - Effective January 1, 2020 through December 31, 2020
  • QI-1932A - Medicaid Fee-for-Service REVISED Hospice Nursing Facility Rate for Hospice Hilo - Effective                                           January 1, 2020
  • QI-1932 - Medicaid Fee-for-Service Hospice Nursing Facility Rate for Hospice Hilo - Effective January 1, 2020
  • QI-1931 - Medicaid Fee-for-Service Hospice Nursing Facility Rate for St. Francis - Effective January 1, 2020
  • QI-1930A - Medicaid Fee-for-Service REVISED Hospice Rates - Effective January 1, 2020 through June 30, 2020
  • QI-1930 - Medicaid Fee-for-Service Hospice Rates - Effective January 1, 2020 through June 30, 2020
  • QI-1929 - Electronic Visit Verification (EVV) Service Codes and Modifiers
  • QI-1928 - QUEST Integration (QI) Transition of Care (TOC) Files
  • QI-1927 - (Replaced by QI-2149) - QUEST Integraton Coverage for Our Care, Our Choice Act (End of Life Care Option)
  • QI-1926 - (Replaced by QI-2148) - Support Act Med-QUEST Division Minimum Standards Effective October 1, 2019
  • QI-1925 - Medicaid Rural Health Clinic Prospective Payment System Rates for North Hawaii Clinics
  • QI-1924 - Provider Enrollment of Home and Community-Based Services (HCBS) Providers and Home Health Agencies
  • QI-1923 - Payment Suspension to Provider (Haumea Home Health Agency LLC) restored Effective September 10, 2019
  • QI-1922A - Medicaid Fee-for-Service Hospice Rates to include Malama Ola Health Services
  • QI-1922 - Medicaid Fee-for-Service Hospice Rates - Effective October 1, 2019 through September 30, 2020
  • QI-1921 - (Replaced by QI-2147) - Guidelines and Procedures for Transportation, Meals, and Lodging Associated with                     Approved Inter-Island and Out-of-State Medical Services [Replaces QI-1712, dated 07/21/17]
  • QI-1920 - Quality Portion of Auto Assignment Algorithm for QUEST Integration (QI) Members [Supersedes QI-1811]
  • QI-1919 - Payment Suspension to Provider (Evergreen Adult Day Care) restored Effective July 18, 2019
  • QI-1918 - (Replaced by QI-2146) - Primary Care Physicians (PCP) Managed Care Enhanced Reimbursement
  • QI-1917 - Out-of-State and Default Provider Type Clarifications
  • QI-1915A - Medicaid Fee-for-Service REVISED Hospice Nursing Facility Rates for Hospice Hilo - Effective July 1, 2019
  • QI-1915 - Medicaid Fee-for-Service Hospice Nursing Facility Rates for Hospice Hilo - Effective July 1, 2019
  • QI-1914A - Medicaid Fee-for-Service REVISED Hospice Nursing Facility Rate for St. Francis - Effective July 1, 2019
  • QI-1914 - Medicaid Fee-for-Service Hospice Nursing Facility Rate for St. Francis - Effective July 1, 2019
  • QI-1912 - Payment Suspension to Provider (Evergreen Adult Day Care) Effective June 7, 2019
  • QI-1911B - Medicaid Fee-for-Service REVISED Rates Effective July 1, 2019
  • QI-1911A - Medicaid Fee-for-Service REVISED Rates Effective July 1, 2019
  • QI-1911 - Medicaid Fee-for-Service Rates Effective July 1, 2019
  • QI-1908 - Update for Billing codes for Intensive Behavior Therapy (IBT) for Treatment of Children Under 21 Years of                        Age with Autism Spectrum Disorder (ASD)
  • QI-1906 - Medicaid Fee-for-Service Hospice Nursing Facility Rate for Hospice Hilo - Effective January 1, 2019
  • QI-1905 - Medicaid Fee-for-Service Hospice Nursing Facility Rate for St. Francis - Effective January 1, 2019
  • QI-1902 - Service Plan for Members Receiving Long Term Services and Supports (LTSS)

QI Memos – 2018

  • QI-1829 - Direct Acting Antiviral (DAA) Medications for Treatment of chronic Hepatitis C Infection
  • QI-1827 - Medicaid Rural Health Clinic (RHC) Prospective Payment System (PPS) Rates for Kaiser Foundation Health                    Clinics
  • QI-1826A - Annual Reporting and Monitoring Activities Period: January 1, 2019 - December 31, 2019 (Addendum)
  • QI-1826 - Annual Reporting and Monitoring Activities Period: January 1, 2019 - December 31, 2019
  • QI-1825 - Suspended Provider
  • QI-1824 - Medicaid Fee-for-Service FQHC & RHC PPS Rates Effective January 1, 2019 Through December 31, 2019
  • QI-1823 - 2018 Distribution of Going Home Plus Rebalancing Funds for Community Integration Services Coordinator                      (CISC) Positions
  • QI-1822 - Pilot Reporting and Notifications Related to the Provision of Applied Behavioral Analysis (ABA)                 (Attachment A - ABA Pilot Report) 
  • QI-1821 - (Replaced by QI-2144) - Coordination of Services Between QUEST Integration and the 1915(c) Home and                      Community Based-Services Waiver for a Member Under the Age of Twenty-One (21) with Intellectual and/or                    Developmental Disabilities
  • QI-1820 - Medicaid Fee-For-Services (FFS) Nursing Facility Rates Effective January 2, 2019 through June 30, 2019
  • QI-1819 - New Hawaii Medicaid Threshold Rate
  • QI-1818 - QUEST Integration (QI) Transition of Care (TOC) Files
  • QI 1817 - National Drug Rebate Agreement Participation
  • QI-1816A - [Supersedes QI-1816] - Medicaid Fee-For-Service Hospice Rates Effective October 1, 2018 through                                 September 30, 2019
  • QI-1816 - Medicaid Fee-For-Service Hospice Rates Effective October 1, 2018 through September 30, 2019
  • QI 1815 - Medicaid Managed Care Organization Drug Utilization Review Annual Report
  • QI 1814 - Electronic Visit Verification (EVV)
  • QI 1813 - Hawaii Medicaid Quest Integration (QI) Guideline for Prophylaxis of Respiratory Syncytial Virus (RSV)                              Infections in High Risk Infants and Children
  • QI 1812A - (Replaced by QI-2143) - Payment Suspension to Provider (PAC MED) supersedes
  • QI 1812 - Payment Suspension to Provider (PAC MED) Effective July 23, 2108
  • QI 1811 - [Supercedes QI-1701] Quality Portion of Auto-Assignment Algorithm for QUEST Integration (QI) Members
  • QI 1810 - Medicaid Fee-For-Services (FFS) Hospice Nursing Facility Rate for St. Francis (Provider No. 251954) Effective July 1, 2018
  • QI 1809 - Medicaid Fee-For-Services (FFS) Rates Effective July 1, 2018
  • QI 1808 - Enhanced Reimbursement to Eligible Primary Care Physicians and Obstetricians for Managed Care
  • QI 1806 - (Replaced by QI-2142) - Health Plan Submission File Changes
  • QI 1805 - Annual Reporting and Monitoring Activities Period: January 1, 2018 - December 31, 2018
  • QI 1804 - Long Term Care Eligibility on 834 and DMO
  • QI 1803 - Medicaid Certified Nursing Facility Census Reports (DHS 1137)
  • QI 1802 - (EPASRR) Additional February Face-to-Face Trainings for O'ahu
  • QI 1801 - Community Care Foster Family Home (CCFFH) and Expanded Adult Residential Care Home (EARCH)                             Rates Home and Community Based Services Effective January 1, 2018.

QI Memos – 2017

  • QI 1732 - EPASRR (Electronic Pre-admission Screening Resident Review) Additional January Webinar Trainings
  • QI 1731 - Medicaid Fee-For-Service FQHC & RHC PPS Rates. Effective January 1, 2018 through December 31, 2018
  • QI 1730 - Electronic Preadmission Screening Resident Review (ePASRR) Trainings Sign-up, Start Up, and Go-Live
  • QI 1729 - Medicaid Fee-For-Service Hospice Nursing Facility Rate for St. Francis (Provider NO. 251954) - Effective                        January 1, 2018
  • QI 1728 - Medicaid Fee-For-Service Long Term Care Acuity Rates for New Nursing Facility - Kalakaua Gardens
  • QI 1727 - Electronic Preadmission Screening/Resident Review (ePASRR) Soliciting Public and Private Stakeholders                        Suggestion(s)
  • QI 1725A - Medicaid Fee-For-Service Hospice Nursing Facility Care Rates Effective January 1, 2018 through                                      June 30,  2018
  • QI 1724 - QUEST Integration (QI) Transition of Care (TOC) Files
  • QI 1721 - Direct Acting Antiviral (DAA) Medications for Treatment of Chronic Hepatitis C Infection
  • QI 1719 - Medicaid Fee-For-Service Hospice Rates Effective October 1, 2017 through September 30, 2018
  • QI 1718 - Community Care Foster Family Home (CCFFH) and Expanded Adult Residential Care Home (EARCH)                             Rates Home and Community Based Services Effective January 1, 2017
  • QI 1716 - Guidelines for Home and Community Based Services
  • QI 1715 - (Replaced by QI-2213) - Reporting Requirements for 340B Medications Provided by Contract Pharmacies                        and Non-340B Medications Provided by 340B Covered Entities to QUEST Integration (QI) and Community                        Care Services (CCS) Members
                    Download Attachments for QI 1715: A - B - C - Cover Entity Mailing List - DRAMS Extract Flat File
  • QI 1714 - (Replaced by QI-2141) - Transition of Care - Clarification of Financial Responsibility Roles              
                    Download Attachment for QI 1714
  • QI 1713 - Ownership Personnel Submissions & Changes to the Health Plan Add (HPA), HealthPlan Submission (HPS)                    and Provider Master Registry (PMR) Files
  • QI 1712 - Guidelines and Procedures for Transportation, Meals, and Lodging Associated with Approved Inter-Island                        and Out-of-State Medical Services
  • QI 1711 - Payment Suspension to Providers - Effective June 5, 2017
  • QI 1710 - Medicaid Fee-For-Service Rates Effective July 1, 2017
  • QI 1709 - Assisted Living Facility Rates Home and Community Based Services Effective January 1, 2017
  • QI 1708 - Coverage of Intensive Behavioral Therapy (IBT) for Treatment of Children under 21 Years of Age with                                Autism Spectrum Disorder (ASD)
  • QI 1707 - Grievance Acknowledgement Template Revision Download Attachments for QI 1707
  • QI 1706A - QI and CCS Report Tool - Updated Version. Download Attachments for QI 1706A
  • QI 1706 - QI and CCS Report Tool - Updated Version
  • QI 1705 - (Replaced by QI-2140) - Medicaid Fee-For-Service (FFS) Dental Program Formulary
  • QI 1704 - Medicaid Fee-For-Service Hospice Nursing Facility Care Rates Effective January 1, 2017 through                                     June 30, 2017
  • QI 1703 - Annual Reporting and Monitoring Activities Period: January 1, 2017 - December 31, 2017. Download                                Attachments for QI 1703
  • QI 1702A - (Replaced by QI-2139) - Tele-Health Law (Act 226, SLH 2016) Implementation Download Attachment                               for QI 1702A
  • QI 1702 - Tele-Health Law (Act 226, SLH 2016) Implementation
  • QI 1701 - Quality Portion of Auto-Assignment Algorithm for QUEST Integration (QI) Members

 

QI Memos – 2016

  • QI 1601 – Annual Reporting and Monitoring Activities Period: January 1,    2016 - December 31, 2016 Download the Attachments for QI 1601
  • QI 1602 – Changes to the QUEST Integration (QI) Annual Plan Change (APC) Process
  • QI 1603 – Medicaid Fee Schedule - Clarification
  • QI 1604 – Payment Suspension to Provider
  • QI 1605 – Mass Adjustments for Quest Integration (QI) 2015 Revised Rates
  • QI-1606 - (Replaced by QI-2217) - Payment Suspension to Provider - Jennifer Grace Shaw, LMHC
  • QI 1607 – Medicaid Fee-For-Service Rates Effective July 1, 2016
  • QI 1609 – Dental TPA Contract to Hawaii Dental Service (HDS) Effective July 1, 2016
  • QI 1610 – Fee-For-Service Hospice Nursing Facility Care Rates Effective July 1, 2016 through December 31, 2016
  • QI 1610A – Medicaid Hospice Nursing Facility Care Rates Effective July 1, 2016 through December 31, 2016
  • QI 1611 – Hawaii Medicaid Quest Integration (QI) Guideline for Prophylaxis of Respiratory Syncytial Virus (RSV) Infections in High Risk Infants and Children
  • QI 1612 – Medicaid Benefits for Prenatal Screening, Brief Intervention, and Referral to Treatment (SBIRT) Pilot Project
  • QI 1613 – (Replaqced by QI-2137) One Key Question and Contraceptive Coverage 
  • QI 1614 – Direct Acting Antiviral (DAA) Medications for Treatment of Chronic Hepatitis C Infection
  • QI 1615 – Medicaid Benefits for the Prevention of Zika Virus Transmission
  • QI 1616 – Quest Integration (QI) Transition of Care (TOC) Files
    Download the Attachments for QI 1616
  • QI 1617 – Medicaid Fee-For-Service Hospice Rates Effective October 1, 2016 through September 30, 2017
  • QI 1618 – Medicaid Fee-For-Service Hospice Rates Effective October 1, 2016 through September 30, 2017
  • QI 1620 – (Replaced by QI-2138) QI Health Plan and DOHEIP Collaboration 
  • QI 1622 – Medicaid Fee-For-Service Nursing Facility and Hospital Waitlisted Rates Effective January 1, 2017 through June 30, 2017
  • QI 1623 – Medicaid Fee-For-Service FQHC PPS Rates Effective January 1, 2017 through December 31, 2017
  • QI 1623A – Medicaid Fee-For-Service FQHC PPS Rates Effective January 1, 2017 through December 31, 2017

 

QI Memos – 2015

  • QI 1501 – Medicaid Fee-For-Service Hospice Rates for Nursing Facilities Effective January 1, 2015 through June 30, 2015
  • QI 1502 – Self-Direction Forms
  • QI 1503 – Kolea Downtime in Preparation for Wave 2
  • QI 1504 – Coverage of Intensive Behavioral Therapy for Autistic Spectrum Disorder (ASD)
  • QI 1506 – Transition of Care (TOC) Information
  • QI 1507 – (Replaced by QI-2136) Universal Precautions for QUEST Integration Members  Receiving At-Risk and Home and Community Based Services 
  • QI 1508 – Payment Suspension to Provider
  • QI 1509 – Medicaid Inpatient Fee-For-Service Rates Effective July 1, 2015
  • QI 1510 – Hepatitis C Medication Coverage Guidelines
  • QI 1511 – Payment Suspension to Provider
  • QI 1513 – Quest Integration (QI) Transition of Care (TOC) Files
  • QI 1514 – Allowable Bill Types for Intermediate Care Facility (ICF) and Sub-Acute Services
  • QI 1515 – Coverage of Intensive Behavioral Therapy (IBT) for Treatment of Children Under 21 Years of Age with Autism Spectrum Disorder (ASD)
  • QI 1516 – ICD-10 Conversion Guidelines
  • QI 1517 – Medicaid Fee-For-Service Hospice Rates for Nursing Facilities - Effective July 1, 2015 through December 31, 2015
  • QI 1518 – Medicaid Hospice Rates - Effective October 1, 2015 through December 31, 2015 and January 1, 2016 through September 30, 2016
  • QI 1520 – Medicaid Hospice Rates - Effective October 1, 2015 through December 31, 2015 and January 1, 2016 through September 30, 2016
  • QI 1521 – Medicaid Fee-For-Service Nursing Facility and Hospital Waitlisted Rates Effective January 1, 2016 through June 30, 2016
  • QI 1522 – Expansion of Claim Reference Number (CRN) in Encounter System
  • QI 1523 – Drug Utilization Code Requirement
  • QI 1524 – Medicaid Fee-For-Service Hospice Rates for Nursing Facility - Effective January 1, 2016
  • QI 1524A – Medicaid Fee-For-Service Hospice Rates for Nursing Facility Care - Effective January 1, 2016 through June 30, 2016
  • QI 1525 – Update to Pay-For-Performance (P4P) Incentives Performance Measures
  • QI 1526 – Medicaid Fee-For-Service FQHC PPS Rates Effective January 1, 2016 through December 31, 2016
  • QI 1527 – 2016 Performance Improvement Projects for QUEST Integration

FFS Memos - 2022

  • FFS 2206 - Payment Suspension to Provider - Michael Izumi, DDS
  • FFS 2204 - APR DRG Billing Guidance (Update to FFS 21-06A)
  • FFS 2203A  - COVID-19 Home Test Kits (NON-PCR) (Replaces FFS 22-03)
  • FFS 2203 - (Replaced by FFS 22-03A) - COVID-19 Home Test Kits (NON-PCR)
  • FFS 2202 - Emergency Transportation to Alternative Destinations
  • FFS 2201 - Update on Orally Administered Drugs to Terminate a Pregnancy

FFS Memos - 2021

  • FFS 2120 - 2022 Updates to the Medicaid Dental Fee Schedule
  • FFS 2119 - QI Health Plan and DOHEIP Collaboration (Replaces CTR-1603)
  • FFS 2118 - Coordination of Services Between Quest Integration and the 1915(c) Home and Community Based-Services                     Waiver for a Member Under the Age of Twenty-One (21) with Intellectual and/or Developmental Disabilities                       (Replaces CTR-1803) 
  • FFS 2117 - Transition of Care - Clarification of Financial Responsibility Roles (Replaces FFS 1706, CTR-1702) 
  • FFS 2116 - Medicaid Fee-For-Service (FFS) Dental Program Dental Formulary (Replaces FFS 1702)
  • FFS 2115 - Tele-Health Law (Act 226, SLH 2016) Implementation (Replaces FFS-1701A)
  • FFS 2114 - Universal Precautions for Quest Integration Members Receiving At-Risk and Home and Community Based                       Services (HCBS) (Replaces FFS-M15-05)
  • FFS 2113 - Medicaid Fee-For-Service FQHC & RHC PPS Rates - Effective January 1, 2022 - December 31, 2022
  • FFS 2111A - COVID-19 Monoclonal Antibody Treatment - FQHC/RHC Reimbursement for Administration
  • FFS 2111 - COVID-19 Monoclonal Antibody Treatment - FQHC/RHC Reimbursement for Administration
  • FFS 2109 - Continued Coverage of Audio-Only Visits Through Federal Public Health Emergency (PHE)
  • FFS 2108 - Provider Master Registry (PMR) File and Provider Type
  • FFS 2107- Mandatory Pickup/Dropoff Locations for Non-Emergency Transportation (ATTACHMENT)
  • FFS 2107- Mandatory Pickup/Dropoff Locations for Non-Emergency Transportation
  • FFS 2106A - (Updated by FFS 22-04) - Implementation of all Patients Refined Diagnosis Related Groups (APR DRG)
  • FFS 2106 - Implementation of all Patients Refined Diagnosis Related Groups (APR DRG) 
  • FFS 2105 - Orally Administered Drugs to Terminate a Pregnancy During the Public Health Emergency (PHE)
  • FFS 2104 - Updated Guidelines for Submittal and Payment of Induced/Intentional Termination of Pregnancy (ITOP)                             Services; FFS 2104 Attachment A
  • FFS 2103 - Medicaid Rural Health Clinic Prospective Payment System Dental Rates for Kahuku Medical Center -                               Effective October 12, 2020 through December 31, 2021
  • FFS 2102 - Medicaid Eligibility for Freely Associated States Under the Compact of Free Association (COFA) Citizens
  • FFS 2101 - Civil Rights Awareness Training Requirements

FFS Memos - 2020

  • FFS 2017 -  Dental Services Requiring General Anesthesia Performed in a Hospital Setting
  • FFS 2016 - Medicaid Fee-For-Service Federally Qualified Health Center (FQHC) & Rural Health Center (RHC)                                   Prospective Payment System (PPS) Rates - Effective January 1, 2021 through December 31, 2021
  • FFS 2014 - COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the                       Uninsured
  • FFS 2013 - Interim Caries Arresting Medicament Application - D1354 Adult Dental Emergency Coverage
  • FFS 2012 - Required Quantity Prescribed Field in Point of Sale Claim Submission for Schedule II Drugs
  • FFS 2011 - Universal Precautions for QUEST Integration Members Receiving At-Risk and Home and Community Based                     Services (Addendum to FFS-M15-05)
  • FFS 2010 - Opioid Medications Morphine Milligram Equivalents (MME) for Chronic Pain Treatment, International                                 Classification of Diseases, Tenth Revision (ICD-10) on Opioid Prescriptions, Opioid Prior Authorization (PA)                     Criteria, Initial Concurrent Opioid and Benzodiazepines Days Suppy, Electronic Prescription Accountability                       Requirement, and Opioid Therapy Informed Concent Process
  • FFS 2009 - Coverage of Services for Autism Spectrum Disorder via Telehealth
  • FFS 2008 - Teledentistry and Telephonic Guidance During Public Health Emergency Period in Response to COVID-19
  • FFS 2006 - Telehealth Guidance for Public Health Emergency - Telephonic Services and Services Billable by Qualified                       Non-Physician Health Care Professionals
  • FFS 2005 - Telehealth Guidance During Public Health Emergency Related to COVID-19
  • FFS 2004 - Federally Qualified health Center Telehealth Guidance During Public Health Emergency Period in Response                     to COVID-19
  • FFS 2003 - Tele-Health Payment Guidance for Federally Qualified Health Centers (FQHC)
  • FFS 2002 - New State Medicaid ID Card Design
  • FFS 2001 - 2020 Changes and Additions to the Medicaid CDT Code Listing

FFS Memos - 2019

FFS Memos - 2018

  • FFS 1810 - Direct Acting Antiviral (DAA) Medications for Treatment of chronic Hepatitis C Infection
  • FFS 1809A - Correction to Interim Caries Arresting Medicament Application D1354
  • FFS 1809 - Topical Application of Fluoride - D1206 and D1208 Interim Caries Arresting Medicament Application - D1354                                                                   
  • FFS 1807 - Medicaid Fee-For-Service FQHC & RHC PPS Rates Effective January 1, 2019 Through December 31, 2019
  • FFS 1806 - National Drug Rebate Agreement Participation
  • FFS 1805 - Hawaii Medicaid Quest Integration (QI) Guideline for Prophylaxis of Respiratory Syncytial Virus (RSV)                               Infections in High Risk Infants and Children   
  • FFS 1803 - Review of Medical Claims for Individuals Eligible Under Emergency Medical Assistance
  • FFS 1802 –Medicaid Certified Nursing Facility Census Reports (DHS 1137)
  • FFS 1801 – (EPASRR) Additional February Face-to-Face Trainings for O'ahu

FFS Memos – 2017

  • FFS 1714 – ePASRR (Electronic Pre-admission Screening Resident Review) Additional January Webinar Trainings
  • FFS 1713  Medicaid Fee-For-Service FQHC & RHC PPS Rates. Effective January 1, 2018 through December 31, 2018
  • FFS 1712 – Electronic Preadmission Screening Resident Review (ePASRR) Trainings Sign-up, Start Up, and Go-Live
  • FFS 1711 - Electronic Preadmission Screening/Resident Review (ePASRR) Soliciting Public and Private Stakeholders Suggestion(s)
  • FFS 1710 – Direct Acting Antiviral (DAA) Medications for Treatment of Chronic Hepatitis C Infection
  • FFS 1708A – Enhanced Reimbursement to  Eligible Primary Care Physicians and Obstetricians for Managed Care
  • FFS 1708 – Enhanced Reimbursement to Eligible Primary Care Physicians and Obstetricians for Managed Care
  • FFS 1707 – Hawaii Medicaid Quest Integration (QI) Guideline for Prophylaxis of Respiratory Syncytial Virus (RSV) Infections in High Risk Infants and Children
  • FFS 1706 – Transition of Care - Clarification of Financial Responsibility Roles (Replaced by FFS 2117)
  • FFS 1705 – Medicaid Fee-For-Service FQHC PPS Rates Effective January 1, 2017 through December 31, 2017
  • FFS 1703 – Coverage of Intensive Behavioral Therapy (IBT) for Treatment of Children Under 21 Years of Age with                              Autism Spectrum Disorder (ASD)
  • FFS 1702 – Medicaid Fee-For-Service (FFS) Dental Program Dental Formulary (Replaced by FFS 2116)
  • FFS 1701 – Printing Approval Form
  • FFS 1701A – Tele-Health Law (Act 226, SLH 2016) Implementation (Replaced by FFS 2115)
  • FFS 1701 – Tele-Health Law (Act 226, SLH 2016) Implementation

FFS Memos-2016

  • FFS 1607 – Affordable Care Act (ACA) 1557 Requirements and Compliance
  • FFS 1605 – Medicaid Benefits for the Prevention of Zika Virus Transmission
  • FFS 1604 – Direct Acting Antiviral (DAA) Medications for Treatment of Chronic Hepatitis C Infection
  • FFS 1603 – Hawaii Medicaid Quest Integration (QI) Guideline for Prophylaxis of Respiratory Syncytial Virus (RSV)                              Infections in High Risk Infants and Children
  • FFS 1601 – 2016 Dental TPA Contract to Hawaii Dental Service (HDS) Effective July 1, 2016

 

FFS Memos – 2015

  • FFS 1514 – Medicaid Hospice Rates - Effective October 1, 2015 Through December 31, 2015 and January 1, 2016 Through September 30, 2016
  • FFS 1513 – Revised DHS 1178 Form for Preadmission Screening Resident Review (PASRR)
  • FFS 1513 – Attachment Part A, B, C
  • FFS 1512 – Revised Guidelines for Submittal and Payment of Induced/Intentional Termination of Pregnancy (ITOP) Claims
  • FFS 1511 – lCD-10 Conversion Guidelines
  • FFS 1510 – Coverage of Intensive Behavioral Therapy (IBT) for Treatment of Children Under 21 Years of Age with Autism Spectrum Disorder (ASD)
  • FFS 1509 – Allowable Bill Types for Intermediate Care Facility (ICF) and Sub-Acute Services
  • FFS 1508 – Hawaii Medicaid Quest Integration Guideline for Prophylaxis of Respiratory Syncytial Virus (RSV) Infections in High Risk Infants and Children
  • FFS 1507 – Preadmission Screening Resident Review (PASRR)
  • FFS 1506 – Transition of Care for State-Funded Medical Assistance Program Beneficiaries
  • FFS 1505 – Universal Precautions for Quest Integration Members Receiving At-Risk and Home and Community Based Services (Replaced by FFS 2114)
  • FFS 1504 – Transition of State of Hawaii Organ and Tissue Transplant (SHOTT) Program Contractor
  • FFS 1503 – Coverage Of Intensive Behavioral Therapy For Autistic Spectrum Disorder (ASD)
  • FFS 1502A – Cost of Living Adjustment (COLA)/Federal Poverty Level (FPL) - UPDATED
  • FFS 1501 – Allowable Bill Types for Long Term Care Facility Services

 

CCS Memos - 2022

  • CCS-2205- APR DRG Billing Guidance (Update to CCS-2106A)
  • CCS-2204- Requirements for Health Plans to Submit NDC Code and NCPDP Units on Encounters
  • CCS-2202- Requirement for Health Plans to Submit the CN1 Segment on Encounters (Replaces CCS-2110)
  • CCS-2201- Emergency Transportation to Alternative Destinations 

CCS Memos - 2021

  • CCS-2112- Revised Grievances and Appeals Templates (Replaces CCS-1901)
  • CCS-2111- Transition of Care - Clarification of Financial Responsiblity Roles (Replaces CCS-1702) 
  • CCS-2110 - (Replaced by CCS-2202) - Requirement for Health Plans to Submit the CN1 Segment on Encounters  
  • CCS-2109- Covid-19 Pandemic Action Plan for QI Health Plans - Part VII
  • CCS-2108- Provider Master Registry (PMR) File and Provider Type
  • CCS-2107- Mandatory Pickup/Dropoff Locations for Non-Emergency Transportation (ATTACHMENT)
  • CCS-2107- Mandatory Pickup/Dropoff Locations for Non-Emergency Transportation
  • CCS-2106A - (Updated by CCS-2205) - Implementation of all Patients Refined Diagnosis Related Groups (APR DRG)
  • CCS-2106- Implementation of all Patients Refined Diagnosis Related Groups (APR DRG)
  • CCS-2105 - Community Integration Services (CIS) Rapid Cycle Assessments (RCAs)
  • CCS-2103 - Community Integration Services (CIS) Data Requirements
  • CCS 2102 - Community Integration Services (CIS) Implementation Guidelines: Overview, Member Eligibility, Service Delivery, Coordination & Reimbursement
  • CCS 2101 - Civil Rights Awareness Training Requirements

CCS Memos - 2020

  • CCS 2001 - COVID-19 Pandemic Action Plan for CCS Health Plan

CCS Memos - 2019

CCS Memos - 2018

  • CCS 1801 - Annual Reporting and Monitoring Activities Period: January 1, 2018 - December 31, 2018
  • CCS 1802 - Medicaid Managed Care Organization Drug Utilization Review Annual Report
  • CCS 1803 - Revised Templates for Denial of Payment, Denial of Service Authorization and Denial of Service
  • CCS 1804 - Annual Reporting and Monitoring Activities Period: January 1, 2019 - December 31, 2019

CCS Memos – 2017

  • CCS 1702 – Transition of Care - Clarification of Financial Responsibility Role (Replaced by CCS-2111)
  • CCS 1703 – Reporting Requirements for 340B Medications Provided by Contract Pharmacies and Non-340B Medications Provided by 340B Covered Entities to QUEST Integration (QI) and Community Care Services (CCS) Members

CCS Memos – 2016

  • CCS 1601 – Annual Reporting and Monitoring Activities Period: January 1, 2016 - December 31, 2016

CCS Memos – 2015

  • CCS 1501 – CCS Report Formats
  • CCS 1502 – Annual Reporting and Monitoring Activities Period: July 1, 2015 - December 31, 2015 

CCS Memos – 2014

  • CCS 1401 – Bill Type 89X
  • CCS 1402 – DHS 1147 Approval for Individuals with Mental Illness
  • CCS 1403 – Annual Reporting and Monitoring Activities Period: July 1, 2014 - June 30 2015

CTR Memos - 2021

  • CTR 2103A - Payment Suspension to Providers (Hawaii Dental Clinic) (Addendum CTR 2103)
  • CTR 2103 - Payment Suspension to Providers (Hawaii Dental Clinic)
  • CTR 2102 - Medicaid Rural Health Clinic Prospective Payment System Dental Rates for Kahuku Medical Center - Effective October 12, 2020 through December 31, 2021.
  • CTR 2101 - Civil Rights Awareness Training Requirements

CTR Memos - 2020

  • CTR 2005 - Medicaid Fee-For-Service Federally Qualified Health Center (FQHC) & Rural Health Clinic (RHC) Prospective Payment System (PPS) Rates - Effective January 1, 2021 through December 31, 2021
  • CTR 2004 - Dental Services Requiring General Anesthesia Performed in a Hospital Setting
  • CTR 2003 - Telehealth Guidance During the Public Health Emergency Related to EPSDT Visits
  • CTR 2002 - Revised Dental Claim Procedure - Listing of Procedures Performed
  • CTR 2001 - New State Medicaid ID Card Design  

CTR Memos - 2019

  • CTR 1902 - 2019 Changes and Additions to the Medicaid CDT Code Listing
  • CTR 1901 - Reimbursement for Procedures Related to Federally Qualified (FQHC) Teledentistry Services

CTR Memos - 2018

  • CTR 1806A - Correction to Interim Caries Arresting Medicament Application D1354
  • CTR 1806 - Topical Application of Fluoride - D1206 and D1208                                                    Interim Caries Arresting Medicament Application - D1354
  • CTR 1805 - Medicaid Fee-For-Service FQHC & RHC PPS Rates Effective January 1, 2019 Through December 31, 2019
  • CTR 1804 - 2018 Distribution of Going Home Plus Rebalancing Funds for Community Integration Services Coordinator (CISC) Positions
  • CTR 1803 - Coordination of Services Between QUEST Integration and the 1915(c) Home and Community Based-Services Waiver for a Member Under the Age of Twenty-One (21) with Intellectual and/or Developmental Disabilities (Replaced by FFS 2118)
  • CTR 1802 - National Drug Rebate Agreement Participation

 

CTR Memos – 2017

  • CTR 1703 – Medicaid Fee-For-Service FQHC & RHC PPS Rates Effective January 1, 2018 - December 31, 2018

  • CTR 1702 – Transition of Care - Clarification of Financial Responsibility Roles
    Download the Attachments for CTR 1702

  • CTR 1701 – Medicaid Fee-For-Service FQHC PPS Rates Effective January 1, 2017 through December 31, 2017


CTR Memos – 2016

  • CTR 1603 – QI Health Plan and DOHEIP Collaboration (Replaced by FFS 2119)
  • CTR 1602 – Monthly and Quarterly Dental Reports January to December
  • CTR 1601 – FQHC Dental Rates as of January 1, 2016


CTR Memos – 2015

  • CTR 1503 – Update on Federal Bureau of Investigation (FBI) Audit at Med-QUEST Division (MQD) in January 2015
  • CTR 1502 – Transition of Care (TOC) Information
  • CTR 1501 – Transition of State of Hawaii Organ and Tissue Transplant (SHOTT) Program Contractor