Statewide Healthcare RCM Coverage • 158 Cities & Towns
Medical Billing & RCM Services in Hawaii
Delivering tailored medical coding, billing, and credentialing services across Hawaii. Serving healthcare providers, clinics, and hospital groups with an exceptional 98% clean claim rate.
Statewide Regulatory & MAC Compliance Hub
Hawaii Medicare MAC Jurisdiction & Payer Regulations (J-E)
Comprehensive Part A/B Medicare contractor policies, LCD standards, and state Medicaid filing rules for Hawaii medical practices.
98.2% First-Pass Clean Claim Rate
Medicare Administrative Contractor (MAC)
J-E
Jurisdiction E (J-E)
Contractor:
Noridian Healthcare Solutions, LLC (HQ: Fargo, ND)
State Medicaid & Public Health Agency
HI
Hawaii Department of Human Services (Med-QUEST)
Governing Agency:
Hawaii Department of Human Services (DHS)
Medicaid Timely Filing:
12 months from Date of Service
Medicare Timely Filing Window
12 months (365 days) from Date of Service
First-Level Appeals (Redetermination)
120 calendar days from Remittance Advice (Redetermination)
First-Pass Clean Claim Target
98.2% Scrubber Rate
Active Local Coverage Determinations (LCDs) in Hawaii (J-E):
4 Active LCDs
L38397
MolDX: Molecular Diagnostic Services
L34993
Nerve Blockade & Epidural Injections
L34194
Blepharoplasty & Brow Lift
L38904
Wound Care & Cellular/Tissue-Based Products (CTPs)
Regional Billing Nuances & Compliance Safeguards:
California Multi-Locality GPCI Pricing: Split across 9 geographic pricing localities; Box 32 physical service location zip code controls exact GPCI payment.
Medi-Cal Automated 835 Crossover: Retroactive claims older than 1 year require Medi-Cal Delay Reason Code 11 with Medicare Remittance Advice attachment.
Hospital Outpatient Department (OPD) Prior Authorization enforced for blepharoplasty, rhinoplasty, vein ablation, and cervical spinal fusion.
Mandatory single-use drug vial wastage recording with JW/JZ modifiers.
Healthcare Locations & Cities in Hawaii
Select your city below for specialized local medical billing solutions and regional payer expertise.