SHOTT Forms and Resources

Hawaii Medicaid

• Hawaii Medicaid (Med-QUEST)’s website
• Hawaii Medicaid Programs
• Hawaii Medicaid Provider Manual
• Hawaii Medicaid’s Provider Resources
• SHOTT Program Guidelines

Koan Risk Solutions

• Koan Risk Solutions (Koan)’s website

Patient Resources

• Rights & Responsibilities
• Travel/Reimbursement Information
• Guide to Finding a Provider

Provider Resources

• List of Services/Items That Require Authorization (Pages A55-A62)
• Prior Authorization (1144) Form
• Prior Authorization (1144B) Form
• ADRC Referral and Determination/Re-Determination (ADRC) (1180) Form
• Blank Professional Claim Forms
• Blank Institutional Claim Form
• Link to Smart Data Solutions (SDS)
• Link to Koan SpyGlass provider portal
• Koan SpyGlass Provider Portal Instructions