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  • 1-855-838-1370
  • 445 Main Street, 2nd Floor, #1, Saco, ME 04072
  • Mon to Fri 9:00AM to 06:00PM EST
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Shoreline Medical Billing Company is a proud Maine-based company that offers end to end revenue cycle management services to physicians and Medical billing companies in Hawaii. Our goal is to help them manage their business in a way where they can focus on patient care and operations, not paperwork! By providing great services at reduced costs, we have been able to keep our customers since our inception in 2015. Explore our case studies to see how we’ve helped practices overcome complex billing challenges and improve cash flow.

As a medical billing outsourcing company, we have helped our clients grow their business by providing them with the resources they need to succeed while maintaining a competitive edge in today’s industry. We offer timesaving, cost-effective revenue cycle management services to your Hawaii based practice. Ready to outsource your billing needs? We’ll guide you through your receivable account to make sure that your claims are paid.

Best In the Industry

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Shoreline Healthcare Technologies in Hawaii exceeds customer expectations and we are proud of our history, but more importantly we are focused on the future. We have grown in recent years by continuing to invest in technology and people while maintaining a commitment to excellent service and innovation. We have the best customer service and one of the highest success rates for reimbursement, so you know your money will be going where it belongs - back into your pocket.

Hawaii Billing Challenges we solve



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Fragmented Care Delivery Across Neighboring Islands

Hawaii’s Medicaid population is spread across Oʻahu, Maui, Kauaʻi, Hawaiʻi Island, Molokaʻi, and Lānaʻi. Many specialists sit on Oʻahu, while patients live elsewhere. When claims involve travel-related services, telehealth consults, or inter-island care coordination, the billing becomes complicated. Providers often need extra documentation for transport, referrals, and continuity of care because health plans closely audit anything involving travel between islands. We at Shoreline Healthcare Technologies have built encounter packets that clearly show the patient’s care journey, referrals, telehealth notes, transportation logs, and continuity-of-care documents. Our team already works with QUEST plans daily, so we know exactly what they look for when travel or inter-island coordination is involved.

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Hawaii’s Health Plan Contract Cycles and Frequent Policy Shifts

Hawaii’s Med-QUEST program renegotiates plan contracts regularly, and every cycle brings new prior authorization rules, covered benefits, and claim formatting expectations. For providers, these mid-year shifts cause billing friction, some codes might suddenly require PA, certain outpatient procedures move into bundled payment models, or plan-specific modifiers get added. Shoreline has a dedicated compliance unit that tracks Med-QUEST bulletins, plan-specific PA lists, and code rollouts. We push real-time updates into our billing workflow and reconfigure claim rules behind the scenes. As a result all claims stay in sync with the latest rules, no surprise denials from policy changes.

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Higher Dependence on Federally Qualified Health Centers (FQHCs)

FQHCs account for a large share of care delivery in Hawaii, especially on the neighbor islands. Their billing rules differ with per-visit PPS rates, carve-outs, wrap payments and the state has its own nuances on what qualifies for an encounter. Providers often lose revenue because they fail to submit wrap claims correctly or don’t bundle services in the way QUEST expects. We at Shoreline Healthcare Technologies handle all bundling encounter services, prepares wrap claim submissions, tracks missing carve-out opportunities, and corrects visit documentation for PPS.

We at Shoreline Healthcare Technologies provide personalized support tailored to the unique needs of Hawaii providers. Our team of experts understands the intricacies of the Hawaii billing landscape and offers guidance to help practices navigate these challenges effectively with our cloud-based RCM solutions for an optimized Revenue Cycle Management.

Comprehensive Medical Billing Services for Hawaii

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Specialized Services tailored to meet Hawaii Medicaid rules and regulations

🩺 Services 📍Hawaii Specialization 📈 Typical Improvement ⏱️ Turnaround Time
End-to-End Medical Billing Customized workflows for QUEST Integration plans. Handles island-to-island care coordination claims. 20–35% reduction in denials, faster payment cycles across multiple plans. 1-2 weeks
Coding & Compliance Knowledge of Hawaii-specific carve-outs, FQHC encounter rules, behavioral health coding and QUEST plan policy updates. 15–30% improvement in first-pass acceptance rate. Coding completed within 24–36 hours of receiving visit notes.
Denial Management AI based tools to track and flag denial codes and root-cause analysis tailored for Medicaid claim categories, identifies high-risk categories and automate resubmissions. Reduce rate of denial by 75% and with quicker appeals. 5-7 days
AR Cleanup & Denial Management Corrects denials involving inter-island travel, PPS wrap claims, telehealth documentation, and long-term care rules. 40–60% recovery of previously stuck AR; 25% drop in recurring denials. 7–14 days for backlog cleanup; ongoing daily follow-up
Telehealth Billing Special handling of audio-only vs. audio/video rules; supports neighbor-island connectivity issues and platform documentation requirements. 20–40% increase in paid telehealth claims. Same-day telehealth claim processing.
Patient Statements & Follow-Up Communicate with patients and give Explanation of Benefits (EOBs). Includes text/email payment reminders and online payment options. Reduces overdue balances and better collection rates. 1-2 weeks
Audit & Compliance Support Conducts Audit Review and mock audits, including documentation, encounter verification, and claim reconciliation. Minimizes risk of penalties and supports successful audits. Ongoing, depending on audit schedule

Medical Billing Resources for Hawaii

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Comprehensive resources specifically designed for Medicaid Providers to navigate the state’s complex Billing Landscape.

Medicaid Billing Guide

A Complete guide covering all billing requirements, policy updates and compliance standards.

Behavioral & Mental Health Billing rules and guidelines

Specialized billing guidelines and documentation procedures for behavioral health programs.

Revenue Cycle Optimization

Best Practices and Strategies to improve cash flow and reduce denials.

Telehealth and Remote patient Monitoring in Hawaii

Hawaii’s telehealth and RPM guidelines and regulations.

Serving Healthcare Providers Across Hawaii

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From Hawaii to Kalawao, we provide comprehensive medical billing services across all 5 Hawaii counties.

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Hawaii Island Region:

Hawaii County

Maui Region:

Maui, Molokai (part), Lanai, Kahoʻolawe

Oahu Region:

Honolulu County

Kauai Region:

Kauai County

Kalawao Region:

Kalawao County

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Primary Care
Specialty Clinic
Rural Health
Mental Health
Cardiology
Dermatology
Emergency Medicine
Family Medicine
Internal Medicine
Neurology
Oncology
Orthopedics
Pediatrics
Psychiatry
Radiology
Surgery
Urgent Care
Women's Health

Frequently Asked Questions

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FAQs about Medical Billing Services in Hawaii

Q1. How do Providers verify a patient’s eligibility for Medicaid in Hawaii?

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Eligibility is checked through KOLEA, the state’s online portal. Patients often show digital or printed KOLEA notices as proof of coverage. Always verify the specific QUEST Integration plan (HMSA, AlohaCare, Kaiser, Ohana, UHC), because benefits, PA rules, and claim formats differ by plan.

Q2. Why do inter-island or travel-related claims get denied so often?

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Any service involving island-to-island travel requires clear justification like:

  • • why the service wasn’t available locally,
  • • referral notes from the originating island, and
  • • transport documentation because plans review these claims closely as the travel costs and coordination are high.

Q3. Are audio-only mental health visits covered under QUEST Integration plans?

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Yes, but plan rules may vary. HMSA, AlohaCare, and UHC accept audio-only for behavioral health if documentation supports medical necessity. Kaiser has stricter rules. Always check plan-specific telehealth policies.

Q4. What is the timely filing limit for Hawaii Medicaid plans?

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Most QUEST plans follow a 12-month filing limit, but some have shorter windows for corrected claims or appeals (60–120 days). Always document the initial submission date because island clinics often face delays due to staffing shortages.

Q5. How can Shoreline Healthcare Technologies help providers in Hawaii?

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We at Shoreline Healthcare Technologies handle the entire process of RCM Cycle from patient appointment scheduling to eligibility checks, prior auths, coding, claim submissions, denials, and appeals, till payment processing and patient communication ensuring faster payments and compliance with state specific rules. We also offer analytics and process automation to reduce first pass rejects in state systems and to reconcile managed-care encounter reporting.

Compliance & Certifications

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Your data security and compliance are our top priorities.

HIPAA Compliant

Full HIPAA compliance with regular audits

AAPC Certified

Certified Professional Billing Staffs.

Hawaii Licensed

Licensed to operate in Hawaii

Medical Billing Glossary

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Essential Terms for Understanding the Hawaii’s Medical Billing Landscape

AlohaCare

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A community-based local Medicaid health plan in Hawaii that serves low-income families, seniors, and people with disabilities. They manage benefits, authorizations, and claims under the Med-QUEST program.

Hawaii Medical Service Association (HMSA)

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The largest health insurer in Hawaii. HMSA runs both commercial plans and a Medicaid/QUEST Integration plan. Providers must follow HMSA’s specific rules for referrals, claims, and telehealth documentation.

HOKU

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Hawaii’s electronic prior authorization portal used by some health plans (especially HMSA) to submit, track, and manage PA requests for procedures, DME, imaging, and medications. It centralizes PA communication between providers and payers.

KOLEA

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Hawaii’s online eligibility system for Medicaid (Med-QUEST). This is where families apply for coverage, renew benefits, and upload documents. Providers often use KOLEA portal to verify a patient’s Medicaid status.

Med-QUEST (MQD)

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Hawaii’s state Medicaid program, run by the Department of Human Services. Med-QUEST contracts with health plans like HMSA, AlohaCare, Ohana Health Plan, Kaiser, and UHC to deliver benefits to eligible residents.

Our Services

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Shoreline proudly supports physicians, medical groups, and medical billing companies. Following are the revenue cycle management steps we offer.

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Testimonials

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We Care

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From electronic health records, billing services and practice management tools – Shoreline has you covered! In addition to being an industry leader when it comes to pricing, we also provide personalized support for every client, with a team of experts who have worked with physicians and medical groups for years, Shoreline Healthcare Technologies in Hawaii understands how to navigate today’s complex healthcare revenue environment.

Ready to Optimize Your Medical Billing?

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Contact Information

  • 445 Main Street, 2nd Floor, #1, Saco, ME 04072
  • 1-855-838-1370
  • info@shorelinemb.com
  • M-F, 9am - 5pm EST

Why work with us?
  • 40% average denial rate reduction
  • Local billing expertise
  • 24-48 hour claim turnaround
  • Dedicated Hawaii support team