Posted on November 20, 2017 by Chapter Staff
Originally Published in HAPTA’s e-Newsletter, What’s HAPTAnin’ – November 2017

November 22, 2017  (correction of November 20, 2017 posting) –  In mid-October many (but not all) PT providers received a letter from the State of Hawaii Department of Human Services Med-QUEST division requesting completion of a re-credentialing/validation application. The letter asked that you submit this form by Oct. 30, 2017 and provided a link to complete it online. Some providers received a notice to send a $500 payment as well. HAPTA received conflicting information about who really needs to submit the form and the fee so we reached out to the Med-QUEST office for answers and got the following clarifications.

1) Only individual PT providers who bill Medicaid or one of the MCOs (HMSA Quest, Ohana, Aloha Care) directly for services and have an individual Medicaid ID number need to fill out form 1139 – whether they received a letter from DHS or not. We’re hearing from some clinics that some of their PTs received letters and some did not.

If the PT is an institutional provider of Medicaid services, such as in a hospital or home health agency, does not bill separately, and does not have an individual Medicaid ID, then they do not need to fill out 1139 and pay the $500 facility fee. Their facility (hospital, home health agency or other facility)  will file form 1139 for their group of providers and will need to pay the fee for the facility.

Even if you are already a credentialed provider with Aloha Care, HMSA QUEST, Ohana or state Medicaid, you still need to complete the State of Hawaii Medicaid Provider Application/Change Request Form 1139.

Please go to: and search “1139” to find the form, as well as the instructions.

2)  Individual providers and private practice clinics do not need to pay a fee. Only facilities such as hospitals and home health agencies need to pay the $500 fee. If you already paid the $500 fee requested and you are an individual provider, you should be getting a refund.

We’re seeking additional answers to questions we still have and will keep you updated.

Med-QUEST is severely understaffed and is still getting provider lists from QUEST Integration providers such as Aloha Care, Ohana and HMSA so you might still receive a letter – even after submitting your 1139 form. Submitting the 1139 form as soon as possible could be helpful as Med-QUEST tries to complete everything they need to do to prepare for Jan. 1, 2018. They are trying to get 8,000 providers re-credentialed by Dec. 31.

Please spread the word to your PT friends that treat QUEST patients and bill as individual providers that they need to complete the DHS 1139 form.

Please contact HAPTA at if you have any questions.

Patti Taira-Tokuuke, PT and Shawna Yee, PT, DPT, CSCS, OCS 
HAPTA Payer Relations/Reimbursement Committee

02-07-18: Updated Form link