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Ulu, HI 96814 Phone: 973-1650 (Oahu) or 1-800-434-1002 (NI) Fax: 973-0676 (Oahu) or 1-888-667-0680 (NI) PCP NAME: NAME: Print Form PHONE: D.O.B. PHONE: ACA R E F E R R A L P R I O R ACAP QUEST FAX: CONTACT PERSON: QUEST-ACE AUTHORIZED SIGNATURE: QUEST-Net PCP REFERRAL TO SPECIALTY CARE: Please select referral category by checking the appropriate box and complete the referral effective date range. If date range is not specified, referral will be effective for a period of one (1) year.

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Medical assistance is medical coverage provided for eligible low-income Hawaii residents. Hawaii has two medical assistance programs called Hawaii QUEST and Medicaid Fee-For-Service. Hawaii QUEST, commonly known as QUEST is a program that provides health coverage through health plans for eligible Hawaii residents.

Hawaii adopted Medicaid expansion through the Affordable Care Act, extending eligibility for Medicaid to adults with income up to 138% of the poverty level (133% plus an automatic 5% income disregard). Medicaid expansion took effect in Hawaii in January 2014.

AlohaCare is a non-profit health plan founded in 1994 by Hawaii's Community Health Centers.

AlohaCare Advantage Plus (HMO D-SNP) is a Medicare Advantage Prescription Drug plan that covers Medicare Part A (inpatient care), Part B (outpatient care) and Part D (prescription drugs). We also cover a number of supplemental benefits.

We are mission driven to care for people who are underserved with specific health needs. We provide health care coverage for Hawaii's QUEST Integration (Medicaid) beneficiaries. AlohaCare is a health plan with a Medicare contract and provides Medicare coverage to beneficiaries in Hawaii.

We are mission driven to care for people who are underserved with specific health needs. We provide health care coverage for Hawaii's QUEST Integration (Medicaid) beneficiaries. AlohaCare is a health plan with a Medicare contract and provides Medicare coverage to beneficiaries in Hawaii.

Vincent Catholic Medical Centers of New York.

AlohaCare - Prior Auth Requirement. Make sure AlohaCare has your current address/phone number. Call us at 1-877-973-0712 if you have any questions.

Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income.

Payer Name: Aloha Care|Payer ID: 99030|Professional (CMS1500)/Institutional (UB04)[Hospitals]

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232