Prior Authorization in Hawaii
Soft Home Global provides authorizations submitted ahead of the date of service and chased to a decision for Hawaii practices and billing companies at $1,900 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 prior authorization seat does in Hawaii
Submitted before the date of service and chased through the payer's decision window.
An authorisation found after the visit is a write-off, not a denial to appeal. In Hawaii the work is submitting ahead of scheduling and chasing the decision, against a payment clock that starts only once a clean claim lands.
- Authorizations submitted ahead of scheduling, not after
- Status chased rather than waited on
- Peer-to-peer reviews scheduled when required
- Clinical documentation gathered before submission
- Expiring authorizations flagged before they lapse
- 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 The state says: "Originally enacted in 1974, the Hawaii PHC Act was the first in the nation to set minimum standards of health care benefits for workers" and "Employers must provide health care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 authorisations it decides who you ask. A carve-out means the rules, the portal and the turnaround belong to a different administrator from the one handling the rest of the member’s care, and an authorisation obtained from the wrong one is not an authorisation.
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
$1,900
Per seat, per month, in US dollars — $22,800 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. Medicare Advantage and commercial plans run their own authorizations; for traditional Medicare, the hospital outpatient services on CMS’s prior authorization list are reviewed by this MAC.
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) The authorization gets the service approved; this is the deadline for paying the claim that follows it, once that claim is clean.
How fast must Med-QUEST (QUEST Integration) decide a prior authorization?
Under the federal CMS-0057-F rule, from 1 January 2026: 72 hours for an expedited request and seven calendar days for a standard one, for Medicaid fee-for-service and Medicaid managed care plans alike, counted in calendar time whether the request went by portal, fax or phone. The calculator at softhomeglobal.com/prior-auth-deadline works out the date.
How much does prior authorization cost in Hawaii?
$1,900 per seat per month — $22,800 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