SHOTT Providers

The State of Hawaii Organ and Tissue Transplant (SHOTT) program is a Hawaii Medicaid (Med-QUEST) program for which Koan Risk Solutions (Koan) is the third-party administrator. The SHOTT program is a Hawaii Medicaid Fee-For-Service program.

Provider Credentialing

If you are credentialed with Hawaii Medicaid Fee-For-Service, you are credentialed with the SHOTT program and Koan. If you are not sure if you are credentialed with Hawaii Medicaid Fee-For-Service, please contact Koan at 808-469-4500 or email claims@koanrisksolutions.com, and we can confirm your enrollment status.

Claims

Submitting Claims

Koan accepts both electronic and hard-copy claims. Claims are NOT accepted by fax.

Electronically:
Electronic claims can be submitted through your clearinghouse to Smart Data Solutions (SDS). Koan’s payor ID is 65871. Claims can also be submitted through SDS’s provider portal. For any assistance with SDS’s provider portal, contact SDS at stream.support@sdata.us or 855-297-4436.

Mail:
Hard-copy clams must have a live ink signature and must be mailed to the following address:
Koan Risk Solutions
1580 Makaloa St. #550
Honolulu, HI 96814

Claim Filing Deadline

You have one year from the date of service to submit your claim. Any claim received beyond the deadline will require an approved timely Waiver of Filing Deadline from Hawaii Medicaid. Follow the instructions below to request a waiver.

1. Send a copy of the claim along with a letter addressed to:
   DHS/MQD/FO
   1001 Kamokila Boulevard, Room 317
   Kapolei, HI 96707
2. Include the following info:
   1. Provider Name and NPI
   2. Patient Name and Medicaid ID#
   3. CRN (Claim reference number)
   4. Date of Service
   5. Justification for lateness

Providers will be notified by Med-QUEST of the waiver decision, and if approved, claims may be submitted to Koan for payment. The approval letter must be attached to the claim when submitted.

Checking Claim Status

Provider Portal:
Quickly and easily view claim statuses, patient information, and ask questions. To access the provider portal, go to koan.webspyglass.com and follow the instructions to create an account.

Contact:
Email claims@koanrisksolutions.com or call 808-469-4500 for claim status or questions regarding the provider portal.

Prior Authorizations

Services That Require Authorization

The SHOTT program follows the Hawaii Medicaid Provider Manual to determine which procedures require prior authorization. Refer to “Services/Items That Require Authorization” on pages A55 to A62 in Medicaid’s Provider Manual Appendix 1. If you are unsure if a service requires prior authorization, please email us at claims@koanrisksolutions.com or call 808-469-4500.

Submitting a Prior Authorization (1144) Form

Please fax prior authorization requests to 808-356-1645.

Certain procedures require a prior authorization. The SHOTT program follows the Hawaii Medicaid Provider Manual to determine which procedures require a prior authorization.

If you are unsure if a procedure requires a prior authorization, please contact us, and we can let you know. You can also read more about prior authorizations on Hawaii Medicaid’s “Provider Resources” page.

Once you have completed a prior authorization request, you can fax it to Koan at 808-356-1645.

Grievances and Appeals

You have the right to file a grievance or appeal as a SHOTT provider. The grievance will be investigated, and a resolution to your issue will be provided in sixty (60) days. Once you receive the resolution to your grievance, you have thirty (30) days to request an appeal.

You can also file a grievance or appeal on behalf of a SHOTT beneficiary. The beneficiary will receive a resolution to the grievance or appeal in thirty (30) days. To file a grievance or appeal on a beneficiary’s behalf, you can inform your patient’s case manager of the issue, call Koan at 808-469-4500, or fax a request to Koan at 808-356-1645.