Hawaii Department Of Human Services Coverage Criteria
- Hawaii Department Of Human Services prior authorization
- All Hawaii Department Of Human Services policy updates
Latest Hawaii Department Of Human Services coverage criteria updates9
- Coverage CriteriaClinical/Medical PolicyEff. 2025-12-08Telehealth implementation — Telehealth & Remote Monitoring coverage criteriaState guidance governing delivery, billing, provider eligibility, and documentation requirements for Hawai'i Medicaid telehealth services (includes FFS, QI plans, FQHCs, RHCs, and CCS providers).All Hawaii Department of Human Services updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-12-31Community Palliative Care Benefit ImplementationEstablishes a new Medicaid community palliative care benefit for non-hospital settings for QUEST Integration beneficiaries in Hawaii, describing purpose, implementation, clinical criteria, services, settings, and operational expectations for health plans and providers.All Hawaii Department of Human Services updates
- Coverage CriteriaClinical/Medical PolicyEff. 2018-12-31Direct Acting Antiviral (DAA) Medications for Treatment of Chronic Hepatitis C InfectionDefines coverage criteria and guidance for use of FDA‑approved direct acting antiviral medications to treat chronic hepatitis C infection for Medicaid Fee‑For‑Service, QUEST Integration health plans, providers and pharmacies.All Hawaii Department of Human Services updates
- Coverage CriteriaClinical/Medical PolicyEff. 2018-09-01RSV prophylaxis (palivizumab/Synagis) for high-risk infants and childrenGuideline governing coverage, clinical criteria, dosing schedule, and prior authorization requirements for palivizumab (Synagis) prophylaxis for high-risk infants and children enrolled in Hawaii Medicaid/QUEST Integration for the 2018-2019 RSV season.All Hawaii Department of Human Services updates
- Coverage CriteriaClinical/Medical PolicyEff. 2017-10-04Direct Acting Antiviral (DAA) Medications for Treatment of Chronic Hepatitis C InfectionDefines coverage criteria, limitations, and clinical considerations for Medicaid Fee-For-Service and QI health plans in Hawaii for use of FDA-approved direct-acting antiviral medications to treat chronic hepatitis C infection.All Hawaii Department of Human Services updates
- Coverage CriteriaClinical/Medical PolicyEff. 2017-08-31RSV prophylaxis with palivizumab (Synagis) — Hawaii Medicaid QUEST Integration guidelineCriteria, clinical considerations, and prior authorization requirements for coverage of palivizumab (Synagis) for prophylaxis of respiratory syncytial virus (RSV) in high-risk infants and children for the 2017-2018 RSV season in Hawaii Medicaid QUEST Integration plans.All Hawaii Department of Human Services updates
- Coverage CriteriaClinical/Medical PolicyEff. 2017-01-01Direct Acting Antiviral (DAA) Medications for Treatment of Chronic Hepatitis C InfectionPolicy governing coverage criteria and limitations for FDA‑approved direct acting antiviral medications to treat chronic hepatitis C among Medicaid Fee‑For‑Service and QUEST Integration members in Hawaii.All Hawaii Department of Human Services updates
- Coverage CriteriaClinical/Medical PolicyEff. 2017-01-01Direct acting antiviral (DAA) medications for treatment of chronic hepatitis C infectionPolicy guidance on coverage criteria, limitations, and prescribing requirements for FDA‑approved direct acting antiviral medications used to treat chronic hepatitis C for Hawaii Medicaid (FFS and QUEST Integration) members.All Hawaii Department of Human Services updates
- Coverage CriteriaClinical/Medical PolicyEff. 2016-08-05RSV prophylaxis with palivizumab (Synagis) — Hawaii Medicaid QUEST Integration guidelineGuideline for coverage and authorization of RSV immunoprophylaxis with palivizumab for high-risk infants and children under Hawaii Medicaid QUEST Integration plans during the specified RSV season.All Hawaii Department of Human Services updates
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Tool Description
Search Hawaii Department Of Human Services coverage criteria and medical necessity requirements across 21,000+ policies from 170+ payers.
Search a drug (“Wegovy”), a procedure (“knee replacement”), or a policy name, then filter by payer, specialty, policy type, or effective year. Or start from the largest publishers: UnitedHealthcare coverage criteria and Cigna coverage criteria.
Each result links the full policy page, which lists the clinical requirements, covered codes, and effective dates from the source document.
Pair a criteria search with the prior authorization lookup for approval requirements, the timely filing lookup for claim deadlines, the live policy updates feed for the newest payer publications, and payer profiles for contacts and coverage context.
FAQ
Coverage criteria are the specific clinical requirements a payer sets for covering a drug, procedure, or service: diagnoses, symptom duration, prior treatments tried, age limits, and documentation. They are published inside medical policies and clinical criteria documents, and a claim or authorization that does not meet them is denied as not medically necessary.
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