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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 – 2019
  • 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-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-1930 - Medicaid Fee-for-Service Hospice Rates - Effective January 1, 2020 through June 30, 2020
  • QI-1928 - QUEST Integration (QI) Transition of Care (TOC) Files
  • QI-1927 - QUEST Integraton Coverage for Our Care, Our Choice Act (End of Life Care Option)
  • QI-1926 - 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-1922 - Medicaid Fee-for-Service Hospice Rates - Effective October 1, 2019 through September 30, 2020
  • QI-1921 -  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 - 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

  • 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-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)
  • QI-1821 - 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 - Medicaid Fee-For-Service Hospice Rates Effective October 1, 2018 through September 30, 2019 (supersedes)
  • 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 - 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 - 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 – 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 – 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 – 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 – 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 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 – 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 – 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 – 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 - 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
  • 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
  • FFS 1701 – Printing Approval Form
  • FFS 1701A – Tele-Health Law (Act 226, SLH 2016) Implementation
  • 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
  • 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 - 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 Roles
    Download the Attachments for CCS 1702

  • 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
    Download the Attachments for CCS 1703

CCS Memos – 2016

CCS Memos – 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 - 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
  • 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
  • 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
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