Hawaii Department Of Human Services Prior Authorization Lookup
- Hawaii Department Of Human Services coverage criteria
- All Hawaii Department Of Human Services policy updates
Latest Hawaii Department Of Human Services prior authorization updates17
- Prior AuthReimbursement/Payment PolicyEff. 2026-04-01Children and Adult Dental Fee Schedule — Med-QUEST DivisionProvides the Med-QUEST Division fee schedule for dental services for children and adults, listing procedure codes, descriptions, and reimbursement rates by region/provider type; coverage details and prior authorization requirements are specified in Medicaid Provider Manual Chapter 14.All Hawaii Department of Human Services updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-04-01Medicaid Dental Program — Coverage, Billing and Authorization Rules (Chapter 14)Governs Hawaii Medicaid dental benefits, provider obligations, referral and pre-authorization rules, and program structure for children's (under 21) and adult (21+) dental programs; affects registered dental providers and Medicaid-enrolled patients in Hawaii.All Hawaii Department of Human Services updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-05-01Medicaid Dental Program (Chapter 14) overview and operational policiesGoverns Medicaid dental benefits and program operations in Hawai‘i, describing the Children's and Adult Dental Programs, provider obligations, referrals, pre-authorization rules, and recent benefit updates; affects registered dental providers and Medicaid-enrolled patients.All Hawaii Department of Human Services updates
- Prior AuthClinical/Medical PolicyEff. 2023-01-01Adult Dental Benefits for Medicaid AdultsDefines covered adult dental services and basic limits for Hawaii Medicaid adults age 21 and older, and explains referral resources and prior authorization applicability. Affects Medicaid providers, dentists, FQHCs, and related clinics in Hawaii.All Hawaii Department of Human Services updates
- Prior AuthClinical/Medical PolicyEff. 2023-01-01Adult dental benefits for Medicaid adultsThis memorandum establishes that, effective January 1, 2023, Medicaid adult dental benefits are available to adult Medicaid members (age 21 and older) in Hawaii and outlines covered services, limitations, and prior authorization notes.All Hawaii Department of Human Services updates
- Prior AuthReimbursement/Payment PolicyEff. 2021-06-02ICD-10 Conversion Guidelines — Use of Unspecified Diagnosis Codes, Specificity, and Prior Authorization RequirementsGuidance from Hawaii Department of Human Services Med-QUEST Division on acceptable ICD-10 diagnosis code use, specificity expectations, and prior authorization requirements affecting QUEST Integration, Fee-For-Service, and Community Care Services LTSS/HCBS providers.All Hawaii Department of Human Services updates
- Prior AuthClinical/Medical PolicyEff. 2021-01-01Dental Services Requiring General Anesthesia Performed in a Hospital SettingMemorandum describing new prior authorization requirements and required supporting forms for pediatric dental procedures performed with general anesthesia in a hospital setting for Hawaii Medicaid fee-for-service and FQHC dental providers.All Hawaii Department of Human Services updates
- Prior AuthClinical/Medical PolicyEff. 2021-01-01Dental Services Requiring General Anesthesia Performed in a Hospital SettingMemorandum outlining new prior authorization documentation and process for pediatric dental procedures requiring general anesthesia performed in hospital-based settings for Hawaii Med-QUEST fee-for-service dental providers and FQHCs.All Hawaii Department of Human Services updates
- Prior AuthClinical/Medical PolicyEff. 2021-01-01Dental services requiring general anesthesia performed in a hospital settingMemorandum describing new prior authorization requirements and supporting forms for pediatric dental procedures performed under general anesthesia in a hospital setting for Hawaii Med-QUEST fee-for-service dental providers and FQHCs.All Hawaii Department of Human Services updates
- Prior AuthClinical/Medical PolicyEff. 2020-08-01OPIOID MEDICATIONS MME LIMITS, ICD-10 REQUIREMENT, AND PRIOR AUTHORIZATION CRITERIAMed-QUEST (Hawaii DHS) policy governing opioid prescribing limits (MME), ICD-10 coding on opioid prescriptions, prior authorization requirements, concurrent opioid-benzodiazepine limits, and informed consent for Fee-For-Service (FFS) Medicaid providers in Hawaii.All Hawaii Department of Human Services updates
- Prior AuthClinical/Medical PolicyEff. 2018-09-01RSV prophylaxis (palivizumab) for high-risk infants and childrenGuideline governing coverage and prior authorization for palivizumab (Synagis) prophylaxis against respiratory syncytial virus (RSV) for high-risk infants and children enrolled in Hawaii Medicaid QUEST Integration and Medicaid FFS during the 2018-2019 RSV season.All Hawaii Department of Human Services updates
- Prior AuthClinical/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
- Prior AuthClinical/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
- Prior AuthClinical/Medical PolicyEff. 2016-08-05Guideline for Prophylaxis of Respiratory Syncytial Virus (RSV) Infections in High-Risk Infants and ChildrenGuideline governing coverage and prior authorization of palivizumab for prevention of RSV infection in high-risk infants and children under Hawaii Medicaid QUEST Integration for the 2016-2017 RSV season.All Hawaii Department of Human Services updates
- Prior AuthClinical/Medical PolicyEff. 2015-06-03Hepatitis C medication coverage guidelines (Direct-acting antiviral medications for chronic HCV)Coverage guidelines for prior authorization and medical necessity of FDA‑approved direct-acting antiviral medications for chronic hepatitis C infection for QUEST Integration Medicaid managed care plans in Hawaii.All Hawaii Department of Human Services updates
- Prior AuthClinical/Medical PolicyCoverage of Intensive Behavioral Therapy (IBT) / Applied Behavior Analysis (ABA) for Children with Autism Spectrum Disorder (ASD)Guidance for QUEST Integration (QI) health plans and providers on coverage, access, and prior authorization for Intensive Behavioral Therapy (including ABA) for Medicaid beneficiaries under 21 with ASD in Hawaii.All Hawaii Department of Human Services updates
- Prior AuthClinical/Medical PolicyCoverage of Intensive Behavioral Therapy for Autistic Spectrum Disorder (ASD)This memorandum defines coverage, billing, provider qualifications, supervision, and prior authorization requirements for intensive behavioral therapy (ABA) for individuals with ASD under Hawaii DHS Med-QUEST; it applies to QUEST Integration Health Plans and Fee-For-Service providers.All Hawaii Department of Human Services updates
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Tool Description
Search Hawaii Department Of Human Servicesprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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