AlohaCare Customer Service: Expert Guide for Members and Providers

Overview and Key Contacts

AlohaCare is a Hawaii-based nonprofit managed care organization established in 1994 that focuses on Medicaid (QUEST), Medicare, and Dual-Eligible beneficiaries. For most member interactions the primary official website is https://www.alohacare.org — this is the definitive source for plan documents, provider directories, Summary of Benefits, and downloadable forms. Always confirm plan-specific details (coverage tiers, formularies and provider networks) there because benefit design can change annually, typically effective January 1.

Primary member contact historically is AlohaCare Member Services; as of mid-2024 the common member phone contact is 1-877-973-0714 (toll-free) with TTY relay 711 for hearing-impaired members. Standard phone hours are business weekdays, typically 8:00 a.m.–5:00 p.m. HST; urgent clinical matters can often be routed to clinical staff 24/7 via nurse lines—check the website for current nurse-line number and hours before calling.

Channels of Communication and Response Expectations

AlohaCare supports multiple service channels: phone (Member Services), secure member portal, online contact forms, fax for providers, and postal mail for formal appeals and documentation. For routine inquiries—ID card requests, PCP changes, benefit clarifications—phone or the member portal will typically resolve matters within 3–5 business days. For requests requiring clinical review (prior authorization, service authorization, complex case management) expect longer timelines because clinical teams must review records and consult network providers.

When interacting with customer service, request and record the representative’s name, date/time, and case or reference number. AlohaCare and other managed-care plans document calls; having the reference number reduces repeat escalation time. If you need written confirmation, ask the agent to send a secure message through the member portal or a follow-up letter to the member’s mailing address on file.

What to Prepare Before Calling

Being organized saves time and speeds resolution. Have the member ID number (on the AlohaCare ID card), full name, date of birth, and phone number ready. If the inquiry concerns a claim or prior authorization, have the date of service, provider name and NPI, claim number (if available), and any prior authorization or referral numbers. For pharmacy issues bring the prescription name/DIN/NDC and the prescribing physician’s contact information.

• Essential checklist to have when contacting AlohaCare: member ID, DOB, last 4 of SSN (if requested), provider name & NPI, date(s) of service, claim or authorization numbers, copy/scans/photos of bills or EOBs, and current medication list including doses.

For appointed representatives (family members or caregivers), confirm whether an Assignment of Representative or HIPAA authorization is required. AlohaCare requires written authorization to discuss protected health information with non-members; the member or legal guardian must complete and submit the plan’s authorization form to Member Services or upload it to the secure portal.

Handling Enrollment, ID Cards and PCP Changes

Enrollment questions range from plan eligibility (Med-QUEST, Medicare) to PCP assignment. Members newly enrolled in QUEST Integration may receive temporary ID letters within 7–10 days; permanent cards sometimes take 2–4 weeks to arrive by mail. If a card is lost or a member changes PCP, Member Services can issue a temporary ID number immediately and order a replacement card, often mailed within 5–10 business days.

When switching a PCP, confirm the effective date and whether authorization is needed for ongoing specialty care. If the member has upcoming scheduled services, ask Member Services to note the need for continuity of care so pre-existing authorization or referrals are honored during the transition period; this avoids claim denials for continuity treatments.

Prior Authorization, Claims and Common Problems

Prior authorization (PA) processes are the most frequent source of customer-service contact. Typical PA requests should include clinical documentation, prior history of treatment, and the ordering provider’s rationale. Providers should submit PAs via AlohaCare’s provider portal or fax number specified on the plan’s website; include ICD-10 and CPT codes, supporting notes, and requested duration of service to prevent incomplete-review delays.

For claims disputes, start by checking the Explanation of Benefits (EOB) to identify denial reason codes. If a claim was denied for lack of authorization or incorrect coding, correct and resubmit with supporting documentation. Always ask the representative for the internal claim reference number and expected adjudication timeframe—many routine claim corrections are processed within 14–30 calendar days after receipt of complete documentation.

Appeals, Grievances and Escalation Paths

If you disagree with a coverage decision, AlohaCare’s standard steps are: (1) file a grievance (for service dissatisfaction) or (2) file an appeal (for adverse benefit determinations). Appeal submission methods include secure portal upload, fax, or certified mail—retain proof of submission. For urgent clinical denials, request an expedited review and document clinical risk rationale; plans typically follow regulatory timelines for expedited reviews, but check the written denial for specific deadlines to file.

• Escalation checklist: 1) Call Member Services and request supervisor review; 2) File a written appeal/grievance via member portal or certified mail; 3) If unresolved, contact Hawaii state Medicaid (Med‑QUEST) or the Hawaii Department of Commerce and Consumer Affairs for consumer assistance and regulatory review — links and contacts are on alohacare.org.

Keep copies of all correspondence and contemporaneous notes of phone conversations. If you involve a state agency or ombudsman, include the AlohaCare case/reference numbers and dates to accelerate their review.

Provider Relations and Business Queries

Providers should register for the AlohaCare provider portal to access claim statuses, PA submission forms, and remittance advices. Credentialing and network inquiries are handled by Provider Relations; typical credentialing windows are 60–90 days from complete application but can vary by specialty. Use the provider portal for secure communication and to attach supporting documentation directly to claims or PAs.

For contract, fee-schedule, or credentialing disputes, escalate through Provider Relations and request a written timeline. If you require an immediate contact, check alohacare.org for the most current provider relations phone and fax numbers, and always reference the provider ID and tax ID in your correspondence to avoid routing delays.

Practical Tips to Maximize Efficiency

Record every interaction: date/time, agent name, case number. Use the secure member portal for document uploads to create an electronic trail. For recurring problems (billing errors, repeated denials), request a written case plan or case manager assignment to centralize follow-up and reduce repetitive calls.

Finally, verify any specific phone numbers, fax lines, or mailing addresses on alohacare.org before sending sensitive documents. Regulatory rules and plan contacts can change year to year; verify “as of” dates on plan documents and keep a printed copy of critical communications for at least 2 years for audit or appeal purposes.

How much is AlohaCare?

AlohaCare Advantage Overview

Plan ID H5969-003-0 Overview
Plan Year:	2025
Monthly Premium:	$0.00 Plus your Medicare Part B premium.
Health Plan Deductible:	$0.00
Annual Out-of-Pocket Maximum:	$9,350.00 (In-Network)

Does AlohaCare cover vision?

AlohaCare Advantage Plus benefits include: Doctor visits. Hospital coverage. Vision services.

What is the phone number for AlohaCare credentialing?

Contact Us
You may contact our Provider Relations Call Center at 808-973-1650 or toll-free at 1-800-434-1002 or submit your inquiry via email to [email protected] if you have any questions.

Is AlohaCare Hawaii Medicaid?

We specialize in QUEST (Medicaid) health insurance to people living on Oahu, Kauai, Molokai, Lanai, Maui and Hawaii Island. We are mission driven to care for people who are underserved with specific health needs. We provide health care coverage for Hawaii’s QUEST (Medicaid) beneficiaries.

What is the highest income to qualify for Medicaid in Hawaii?

You may be eligible for QUEST (Medicaid) if:
You’re 19 or older with a total household income at or below 138% of the federal poverty level (for example, $24,826 for a single person or $51,032 for a family of 4 in 2025)

What is the number for Medicare customer service?

1-800-633-4227
Talk to someone
You can also: Call us at 1-800-MEDICARE (1-800-633-4227).