Health Coordination Service
Members moving back into the community who have been living in hospitals, nursing facilities, and intermediate care facilities for individual with intellectual disability, qualify for this program.
What is Going Home Plus? (GHP) KA#000015163
To properly IAV a QUEST caller, you should ask for these IAV elements.
What is the requester’s full name (if applicable), member’s full name, member’s DOB, and member’s ID number or address? KA 000013736
This entity determines if individuals are eligible for QUEST coverage.
What is the Med-QUEST Division (MQD)? KA 000009255
HPNs can complete demographic changes for QUEST members using this form.
What is the Department of Human Services (DHS) 1179 Form? KA 000009838
If a member expresses dissatisfaction, we need to ask the member if they would like to file this.
What is a FORMAL grievance? KA 000011457
Members may be eligible for long term services and support if they meet these two criteria.
What is if they meet a nursing-facility level of care or if they are at-risk of having to move into an institution to receive care and support? KA#000011305
If the member's address in HMSA's system is listed as homeless, this would be a valid response that satisfies the address element requirement for member IAV.
What is homeless? KA 000013736
The state of Hawaii contracts with these health plans to provide access to QUEST medical and behavioral health services.
What are Alohacare, HMSA, Kaiser, Ohana Health Plan, and UnitedHealthCare? KA 000009255
Members can report Third Party Liability coverage or add a newborn to their coverage by directly notifying HMSA electronically through this portal.
What is their HMSA My Account? KA 000009838
If a member declines to file a formal grievance, we will still submit this for the situation.
What is an INFORMAL grievance? KA 000011457
This is members' primary health care contact and the first person they should go to if they have questions about their health care
What is Quest Health Coordinator? KA#000011795
Once IAV is completed, CMI may be disclosed to adult QUEST members of this age calling on their own behalf.
What is 18 years and older? KA 000013736
Enrollment under QUEST is defined by these three eligibility categories.
What are 1.) Aged, Blind, or Disabled (ABD), 2.) Non-ABD, 3.) ABD and LTSS? KA 000009255
These four types of authorized individuals may request demographic changes for QUEST members under 18 years old.
Who are the head of case, responsible party, authorized representative, or personal representative? KA 000009838
We must provide the member with this when submitting an informal grievance.
What is the Informal Grievance Disclaimer? KA 000011457
Members' must meet these criteria to be eligible for CIS+.
What is 18 years of age or older, experiencing homelessness or be at risk of homelessness, and meet one of the following health criteria, have a behavioral health need, or members assessed to have a complex physical health need? KA#000015149
This designated member of a QUEST household can speak on behalf of the minor children age 17 and younger associated with the case.
Who is the Head of Case? KA 000009691
For benefit purposes, MQD/QUEST defines children as this age and younger.
What is age 20 and younger? KA 000009255
Members who have a KOLEA portal account can make demographic updates via their KOLEA account, but only if their KOLEA account is linked to their QUEST plan. Members will need to contact this party to link their QUEST plan to their KOLEA account.
Who is MedQUEST Division (MQD)? KA 000009838
When QUEST members submit a grievance to CR, CR has this long from the date we receive the member’s grievance to forward it to HMSA's Member Advocacy and Appeals (MAA) department for processing.
What is one business day? KA 000011457
Members' who have Expanded Health Care Needs have one or more of the following medical conditions.
What is serious mental illness, substance use disorder, and/or certain chronic conditions? KA#000015162
The Head of Case information originates from, and is maintained by, this entity.
What is the Med-QUEST Division (MQD)? KA 000009691
Individuals can apply for QUEST coverage by any of these three methods.
What are in person at a local MQD office, by going online (Get Started webpage on Med-QUEST.gov, Med-QUEST Applications webpage of the state of Hawaii MyBenefits website, Am I Eligible webpage on Hawaii MyBenefits website), by getting assistance from various community resources? KA 000016467
QUEST members need to contact the Med-QUEST Division (MQD) directly to request these types of updates (MQD will NOT process these types of requests when submitted to them by HMSA).
What are OOS address updates and requests to terminate their plan? KA 000009838
CR reps will complete the QUEST Grievance and Appeals email template and email it to this address.
What is !QUEST Grievance and Appeals? KA 000009823