Dental Provider Resource Center
Registering with HMSA
Are you interested in joining a healthcare network that promotes wellness in Hawaii? When you register as a participating provider with the Hawaii Medical Service Association (HMSA), you become part of a partnership dedicated to quality healthcare coverage and services. Using the links below, you can:
- Read about HMSA's commitment to healthcare in Hawaii
- Learn about he information and support resources available to participating providers
- Compare the details of the various plans HMSA offers to determine with which plans you would like to participate
- Review the steps required to join HMSA's participating provider network
- Access the participating provider application, which you can complete online, print and mail to HMSA to begin the registration process.
Thank you for your interest in HMSA! We look forward to working with you to become a participating provider. If you have any questions regarding the application process or documents, please call 948-6440 or 1 (800) 792–4672 from the Neighbor Islands. Our Provider Relations Specialists will be happy to assist you.
Navigate to other Join HMSA's Participating Provider Network documents using these links:
The first step to participate with HMSA's dental plan is to complete the provider application packet. Listed below are the HMSA forms that providers must complete and return to HMSA to begin the application process. The forms can be completed directly on your computer; then simply print, sign and mail to HMSA.
Note: These forms, with the exception of the IRS W–9 form, cannot be saved with changes. Any information you enter on the forms will be lost when you close the forms. HMSA recommends you make copies of the completed, printed forms for your records.
HMSA encourages providers to participate in all the programs they are eligible for to enable them to service as many HMSA members as possible. Completing your application for all HMSA plans will eliminate the inconvenience of having to repeat the application and contracting process for other programs later.
Before you start the application, HMSA recommends you print the Document Checklist. This list indicates the materials you should have on hand to ensure you complete the application correctly. You should also use this list to make certain you include all necessary forms and supporting documents when submitting your application packet, which you help your registration go smoothly.
Mail the completed application packet with all forms and documentation to:
HMSA Dental Services
P.O. Box 1320
Honolulu, Hawaii 96807–1320
If you have any questions, please call 948–6440 or 1 (800) 792–4672 from the Neighbor Islands or one of our Provider Relations Specialists.
Thank you for your interest in participating with HMSA's dental plan. We look forward to receiving your application packet soon!
HMSA Provider Application Documents
- Application – Select one of the following forms based on whether you are registering as an individual provider or a business/facility.
(1) HMSA Provider Application Form Dental Providers and Instructions - W–9 Request for Taxpayer Identification Number and Certification (this link will direct you to the IRS website which will allow you to access the current W–9 form)
- Request to Participate –– A Non–Par to Participating Provider Checklist
- Address Change–Closed Location–Additional Location Form
