December 15, 2022

Hawaii Medicaid: New preauthorization form for all health plans

We’ve created a new standardized preauthorization request form to help streamline your process. Effective Jan. 1, 2023, you must use this form with all of our 4 Medicaid health plans:

You can access the fillable form on each health plan’s website. It includes each health plan’s phone numbers, fax numbers and website links. Simply select which health plan you’re sending the request to, fill out the required information and submit. 

Continue to use the current preauthorization form when submitting requests for travel, pharmacy and behavioral health.


Please reach out to Hawaii Intake at 888-980-8728 or Provider Services at 877-842-3210. Thank you.

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