Medical Billing in Hawaii
Soft Home Global provides billing, AR follow-up and denial appeals for Hawaii practices and billing companies at $1,850 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 programme 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.
What a medical billing seat does in Hawaii
Aged accounts receivable called until they close, and denials read, appealed and tracked.
In Hawaii the queue that costs the most is Med-QUEST (QUEST Integration), because its filing window and appeal route are not the commercial ones.
- Worklist worked from the difficult end, not the easy end
- Every call logged with the payer reference and the outcome
- Denials categorised so the same reason stops recurring
- Appeals written and submitted, not just re-bills
- Weekly written summary of what moved and what did not
- Worked during Hawaii business hours, not queued overnight
Most of the Hawaii work we see comes out of Honolulu, Hilo and Kailua, though nothing about a seat depends on where your office is — the queue is worked through your system, not from your building.
What Hawaii law gives you
15 calendar days for electronically filed clean claims; 30 calendar days for claims filed in writing (fastest electronic deadline of any state reviewed here)
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
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 The state says: "Originally enacted in 1974, the Hawaii PHC Act was the first in the nation to set minimum standards of health care benefits for workers" and "Employers must provide health care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
On the commercial side the dominant Blue plan here trades as Hawaii Medical Service Association (HMSA) — Hawaii's Blue Cross and Blue Shield plan; it does not trade under a "Blue Cross Blue Shield of Hawaii" name, which matters mainly because its portal and its appeal route are the ones your seat will spend the most time in. Source
We have not been able to source Hawaii’s own Medicaid filing limit from the regulation itself, so this page does not quote one — the federal floor is twelve months from the date of service and a state may set a shorter window. Ask your Med-QUEST (QUEST Integration) representative for the figure in writing before you rely on it. The states we could source are listed here.
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
$1,850
Per seat, per month, in US dollars — $22,200 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 $1,600 to $2,700; 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 on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.
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.
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) A claim sitting past that is not merely late, it is late against a statute, and the follow-up call changes from "when might this be paid" to "this passed your statutory window on a specific date".
How much does medical billing cost in Hawaii?
$1,850 per seat per month — $22,200 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.
What is the minimum commitment, and how quickly can somebody start?
One seat for one month, cancellable on thirty days notice, and about a week from a signed agreement to a person working your queue. The week of training is not billed. The steps are at softhomeglobal.com/how-it-works.
Is our patient data safe offshore?
A Business Associate Agreement is signed before anyone has access, and the work happens in your own system under a login you issue, so every action is attributable to a person in your audit trail. The controls are listed at softhomeglobal.com/security.
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