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Claims

'Ohana Health Plan aims to ensure that claims are handled as efficiently as possible. Providers can help facilitate timely claim payment by having an understanding of our processes and requirements. The following materials may change periodically so please check for updates. 

Reimbursement PoliciesThis PDF document will open in a new window.

'Ohana Health Plan periodically reviews reimbursement policies to mirror industry standards and updates from the Centers for Medicare and Medicaid and other nationally recognized health and medical societies.


Institutional Claims/Encounter Guides

Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions.

Explains rules and state, line of business and CMS-specific regulations regarding 837I EDI transactions.

Professional Claims/Encounter Guides

Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions.

Explains rules and state, line of business and CMS-specific regulations regarding 837P EDI transactions.

Other Resource Guides

Explains how to receive, load and send 834 EDI files for member information.

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Last Updated On: 12/5/2018