Credentialing in Hawaii
Soft Home Global provides payer enrollment, revalidation and follow-up for Hawaii practices and billing companies at $2,200 per seat per month. Full time, worked during Hawaii business hours, inside your own system.
What is specific to Hawaii
Hawaii delivers almost all Medicaid through QUEST Integration health plans, and the commercial market is concentrated partly because the 1974 Prepaid Health Care Act obliges employers to cover staff working at least twenty hours weekly.
Hawaii’s Medicaid program is Med-QUEST (QUEST Integration). Practices with a meaningful Med-QUEST (QUEST Integration) mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
Medicare here is adjudicated by Noridian Healthcare Solutions, jurisdiction JE. CMS publishes the jurisdictions; checked September 2026.
What a credentialing seat does in Hawaii
Applications, revalidations and payer follow-up, with every enrollment's status visible.
Med-QUEST (QUEST Integration) is not one enrollment but one per plan, and every one of them has a revalidation date that stops payment when it passes. That calendar is the work.
- Initial applications prepared and submitted
- Revalidations tracked ahead of the deadline
- CAQH kept current
- Payer follow-up until an effective date is issued
- Status of every enrollment visible to you
- Worked during Hawaii business hours, not queued overnight
For the statute behind all of this — Hawaii’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Hawaii billing page.
Med-QUEST (QUEST Integration), in practice
Capitated managed care under the QUEST Integration 1115 demonstration — "QUEST Integration uses capitated managed care as a delivery system unless otherwise indicated" — with five health plans listed by Med-QUEST: AlohaCare, HMSA, Kaiser Permanente, Ohana Health Plan and UnitedHealthcare Community Plan. Source: medquest.hawaii.gov
Hawaii is the only state with an employer health-coverage mandate that survives ERISA preemption, so commercial coverage is near-universal among working patients and self-funded ERISA plans are far rarer than on the mainland. The state says: "Originally enacted in 1974, the Hawaii PHC Act was the first in the nation to set minimum standards of health care benefits for workers" and "Employers must provide health care coverage to employees who work at least twenty (20) hours per week and earn 86.67 times the current Hawaii minimum wage a month". Congress carved it out of ERISA at 29 U.S.C. 1144(b)(5): "subsection (a) shall not apply to the Hawaii Prepaid Health Care Act". Source: labor.hawaii.gov
For enrolment that is not a detail, it is a second application. A carved-out benefit is administered by a different organisation, which credentials separately, on its own timetable, and a provider who is live everywhere else can still be out of network for that one service without anybody noticing until the first claim is denied.
Working Hawaii hours
Hawaii runs on Hawaii-Aleutian time, 15 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 12am to 8am. Hawaii does not observe daylight saving, so that overlap is the same every week of the year. For most of the country it moves twice, and the practices that notice are the ones whose payer calls sit near the edge of the window.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Hawaii hours and nobody else’s.
What it costs in Hawaii
$2,200
Per seat, per month, in US dollars — $26,400 a year for one full-time person, forty hours a week, on Hawaii hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Hawaii run $1,500 to $2,500; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Hawaii
About a week from a signed agreement to a person working your queue, and that week of training is not billed on top. The week, step by step, and what is signed before anyone has access.
If working with staff outside the United States is new to your practice, see how a medical billing company structures that seat and why offshore medical billing does not have to mean losing visibility into the work.
Questions
Do you work with Hawaii practices?
Yes. Hawaii accounts are worked during Hawaii office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Hawaii?
Hawaii delivers almost all Medicaid through QUEST Integration health plans, and the commercial market is concentrated partly because the 1974 Prepaid Health Care Act obliges employers to cover staff working at least twenty hours weekly.
Which Medicare Administrative Contractor covers Hawaii?
Noridian Healthcare Solutions, the A/B MAC for jurisdiction JE. It processes Medicare enrollment applications for providers here, and it sends the revalidation notice two to three months before the due date.
When does a Hawaii payer have to pay a clean claim?
15 calendar days for electronically filed clean claims; 30 calendar days for claims filed in writing (fastest electronic deadline of any state reviewed here) It runs from receipt of a clean claim, so claims held back while a provider’s enrollment is pending have not started it.
How often do Hawaii providers have to revalidate?
Medicare: every five years, with sixty days to submit once Noridian sends the notice (42 CFR 424.515). Med-QUEST (QUEST Integration): federal rule requires the state to revalidate every provider at least every five years (42 CFR 455.414), and the state agency sets the exact schedule. A Medicare revalidation left unanswered deactivates billing privileges, and claims stop with it.
How much does credentialing cost in Hawaii?
$2,200 per seat per month — $26,400 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Hawaii queue?
Hawaii is on Hawaii-Aleutian time, 15 hours behind Rawalpindi. The shift here runs 12am to 8am so your seat is at a desk for your full working day. Because Hawaii does not observe daylight saving, that window is identical every week of the year.
Do you handle Med-QUEST (QUEST Integration) as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. Med-QUEST (QUEST Integration) has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
More for Hawaii
Next step
One seat on your Hawaii work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com