Posted on December 6, 2017 by Chapter Staff
Originally Published in HAPTA’s e-Newsletter, What’s HAPTAnin’ – December 2017

LAST UPDATED:   December 6, 2017

Q:    Who needs to submit the DHS 1139 Medicaid Provider application form?

A:    Individual providers with their own Medicaid provider ID number whose services are billed under that number need to fill out and submit DHS 1139 – this includes all private practitioners whether they are an owner or an employee in the private practice.
Providers who are part of a group/facility that bills Medicaid under a group ID number, hospitals, home health agencies, and nursing facilities for instance, do not need to fill out an individual form. Their information will be provided as part of a group application.

Q:    Who needs to pay the $500 fee?

A:    Only groups/facilities such as hospitals, home health agencies, nursing facilities, etc, need to pay the $500 fee. Private practice clinics and their employees do not.

Q:    I’m a student who will graduate this year. Do I need to fill out the form?

A:    No. Until you get your license and unless you get a Medicaid ID number, you don’t need to fill out DHS 1139.

Q:    When do I need to send in DHS 1139 and the related documents?

A:    As soon as possible. DHS is suggesting no later than December 8, 2017 to ensure your application is complete and processed by the January 1, 2018 implementation deadline. If your application package isn’t successfully submitted and processed by January 1, payments to you for treating Medicaid patients may be suspended or denied until the process is completed.

Q:    I paid the $500 fee but think I shouldn’t have. Will I get a refund? If so, when?

A:    Yes you will get a refund. We are unsure of the timing.

Q:    We’re a private practice clinic with 10 PTs. Four of our PTs got letters from Med-QUEST saying they needed to submit DHS 1139. The other six did not get letters from Med-QUEST. Why did some of our PTs get letters and some did not – and which ones need to fill out DHS 1139?

A:    They all do – even the ones who didn’t receive letters. We think some got letters and some didn’t because DHS is still gathering data about who bills for treating Medicaid patients and is sending the letters in waves. They are understaffed and have a high volume of work to complete to get through this enrollment process. If you don’t get one from the Med-QUEST office, you should be getting information from your managed care provider (e.g. HMSA just sent out an announcement  for all of its QUEST providers).

Q:    If I’m already credentialed with Aloha Care, HMSA QUEST, Ohana and others to get paid for treating Medicaid patients, do I still need to fill out DHS 1139?

A:    Yes. A new federal law meant to enhance Medicaid fraud prevention requires DHS/Med-QUEST to perform more comprehensive screening, credentialing and enrollment of all providers.

Q:    Will there be a required onsite visit before I can be credentialed?

A:    All facilities are subject to an unannounced audit, so please make sure you ask for identification and please cooperate with the auditor. One clinic reports they were asked to provide proof or copies of their federal Tax ID status and their state GET license. They were also asked how many patients were being treated at the time.

To find a link to the form, as well as a link to instructions, please go to:

We will add additional questions and answers as they come up. Please contact us with additional questions or thoughts at