1-808-469-4500
1-800-453-1640

koaninfo@koanrisksolutions.com
1580 Makaloa St, Suite 550,
Honolulu, HI 96814

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.

Frequently Asked Questions (Providers)

Healthcare providers and transplant facilities can work with a patient’s QUEST plan to refer a patient to the SHOTT program. Information on the program and its referral process can be found on Med-QUEST’s website.

If you are credentialed with Hawaii Medicaid Fee for Service, you are credentialed with Koan. If you’re not sure if you are credentialed with Hawaii Medicaid Fee for Service, you can call Koan at 808-469-4500, and we’ll check for you.

Contact Koan’s claims department at 808-469-4500 and provide us with the patient’s name and date of birth, the date of service, and the claim amount. Koan also offers a provider portal so providers can check the status of a claim on their own. If you are interested in using Koan’s provider portal, please call 808-469-4500 or email claims@koanrisksolutions.com to request access.

Mail all claims to:
Koan Risk Solutions
1580 Makaloa St. #550
Honolulu, HI 96814

Koan accepts claims electronically through Smart Data Solutions (SDS). Koan’s payor ID is 65871. Koan does not accept claims by fax. Hard-copy claims can be mailed to Koan but must have a live ink signature.

You have one year from the date of service. Any claim submitted more than one year from the date of service requires an approved waiver by Hawaii Medicaid. You can see more information under “Claim Filing Deadline” on this page.

Contact Koan at 808-469-4500, and we will advise you.

If a claim is denied, Koan will send a notification letter with an explanation as to why the claim was denied.

Need an Interpreter?

Attention: If you don’t speak English, language assistance services, free of charge, are available to you.
Call 1-808-469-4500 / 1-800-453-1640 (TTY: 1-877-447-5990 or 711).

(Ilocano) PAKDAAR: Nu saritaem ti Ilocano, ti serbisyo para ti baddang ti lengguahe gna awanan bayadna, ket sidadaan para kenyam.
Awagan ti 1-808-469-4500 / 1-800-453-1640 (TTY: 1-877-447 5990/711).

(Tagalog) PAUNAWA: Kung Nagsasalita ka ng Tagalog, Maaari kang gumamit ng mga servisyo ng tulong sa kika nang walang bayad.
Tumawag sa 1-808-469-4500 / 1-800-453-1640 (TTY: 1-877-447-5990/711).

(Traditional Chinese) 注意: 如果您使用繁體 中⽂. 您可以免費獲得語⾔援助服務.
請致電 1-808-469-4500 / 1-800-453-1640 (電傳打字機: 1 877-447-5990/711).

(Korean) 주의: 한국어를 사용하시는 경우, 언어지 원 서비스를 무료로 이용하실 수 있습니다.
1-808-469-4500 / 1-800-453-1640 (TTY: 1-877-447-5990/711) 번으로 전화해 주십시오.

(Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.
Gọi số 1-808-469-4500 / 1-800-453-1640 (TTY: 1-877-447-5990/711)