CORE CAPABILTIES

HMA is the leader in providing superior health plan administration services. offers flexible, third-party administration of multiple, complex plan designs and integrated in-house services. We work closely with brokers and clients to deliver custom benefits solutions.

Our core capabilities include: 

Medical Administration

Our claim payment systems are designed to provide consistent third-party administration for a wide variety of medical plans and pricing arrangements. Medical benefits are programmed specifically to each customer’s plan. We have the ability to:

  • Administer three-tier benefit plan designs

  • Develop customer-specific contract arrangements

  • Interact with Medicare as a secondary payer of part A and B claims

We also offer superior provider network access and cost containment initiatives.

HMA offers access to the HMN MultiPlan PPO Network. We also have extensive experience in developing and administering alternate and multiple network arrangements.

With HMA’s customized, on-demand reporting, customers can use industry and national benchmarks to measure their plan’s trend. We also provide customers with in-depth plan analysis and recommendations to support continuous improvement and strategic decisions.


Claim Administration

All of our claims administration services are conducted on-site by our experienced team. And with our state-of-the-art proprietary claims processing system, you can count on accurate and cost effective claims processing.
Over 90% of our claims are received electronically. This allows us to automatically adjudicate claims based on your specific benefit plan. Our claims examiners review claims as they are adjudicated to pinpoint any potential errors, or address special circumstances requested by each client. Eligibility and claims information is electronically transmitted daily, allowing for quick turnaround of payments.
We strive to exceed your expectations and commit to aggressive claims processing performance standards.


Online Services

HMA online services give our clients and providers the information they need when they need it. Our online services are fast, easy and free of charge for HMA customers with convenient access to tools and resources.

  • Claim status

  • Eligibility and benefits inquiry

  • Frequently used forms

  • ID card ordering

  • Health information

  • Online reports

  • Prescription benefits information

  • Locate a Provider

Our online services are completely secure. We require all users to register and verify identities so users have access to only their information. We have also worked extensively with qualified HIPAA consultants to ensure compliance.


Pharmacy Benefits Management

We offer integrated strategies and services through our partnership with Catamaran. As one of the industry’s largest and most experienced PBM companies, Catamaran offers an unmatched suite of proven PBM solutions. The complete spectrum of PBM services can be configured to meet each client’s specific needs. This flexibility gives our clients the ability to select the services that make sense for them. We bring expertise to every single client relationship, along with a different approach to pharmacy benefit management.

The benefits of pairing HMA with our preferred pharmacy benefits manager include:

  • Combined electronic data interchange (EDI) for claims, eligibility and reporting

  • A shared service model and integrated call centers

  • Data integration with UMR’s care management programs

  • Single sign-on access for online services

HMA is able to interface with any PBM and has systems in place with a number of national vendors.


Care Management

HMA’s care management programs offer a proactive approach to improving health while reducing health care costs for the long term. We provide our customers with a way to better understand their data, develop a plan and engage members in managing their own health, and execute a strategy for reducing the trend associated with health care costs and lost productivity.

We offer a number of options that can be implemented as a bundled, integrated solution or individually. Our products can help customers maximize savings on today’s claims through utilization and case management and manage tomorrow’s risk through products such as maternity management, disease management and health and wellness.


Utilization Review and Large Case Management

The HMA Utilization Management staff consists of highly trained and educated professionals who specialize in managed care. We are widely regarded as having one of the finest and most comprehensive Utilization Management and Large Case Management programs available. Our emphasis includes ensuring that the proper levels of care are delivered. We also work closely with our clients in developing programs to efficiently administer the utilization of medical services. Utilization management is not about withholding care. It is about matching the patient with the most effective level of care available. The HMA utilization management program does just that. We help eliminate unnecessary procedures, shorten hospital stays, and enhance the delivery of care. We also make sure that the patient received care is proper for the situation and in the most appropriate environment.Our goal is to maintain the highest quality of care. We contain costs without disrupting the healthcare process.

Our utilization management team, led by a Medical Director and registered nurses, work together with the local medical community and the client to provide an integrated managed care approach. We bring a high level of expertise, dedication and innovation to our utilization management programs. The result is an increased level of care and superior service to our clients.

Portfolio of Services

  • Inpatient Review (Precertification and Concurrent Review)

  • Outpatient Surgery Review

  • High-Cost Outpatient Testing Review

  • Referrals Management

  • Disease Management Programs

  • Quality On-Site Programs

  • Case Management

  • High Risk Maternity Programs

  • Mental Health and Substance Abuse Review

  • Ancillary Services Review (Home Health, Home IV, Durable Medical Equipment)


Wellness Services

My Hawaii Wellness is launching a full suite of tools, resources, and health coaching for your employees. We are committed to help support and ensure  wellness in the workplace. Understanding health risks is the first step toward healthier employees and a healthier bottom line. That’s why My Hawaii Wellness, in collaboration with our preferred vendors, offer access to online technologies, as well as on-site local health and wellness resources to all new and renewing clients.

 

Learning more about health often leads to good health. Get your employees started on the path to wellness today!