Non - Traditional Medicaid Providers : Third - Party Administrator

2026-11-03

The State of Hawai ‘ i , through its Medicaid agency , the Department of Human Services ( DHS ), Med - QUEST Division ( MQD ), is issuing this Request for Information ( RFI ) to seek information and comments to better understand options for third - party entities that can provide practice management and administrative support to non - traditional providers who have not historically documented and billed Medicaid for services . These providers may be engaged in housing - and nutrition - related services , pre - release services under the Reentry Program , and other social or community - based services that support Medicaid members ’ health and well - being . MQD is exploring whether and how a third - party administrator ( TPA ) or similar entity ( e . g ., community care hub , network administrator , or other vendor model ) could play two primary roles to support non - traditional providers including : • Capacity building supports to ensure their success as Medicaid providers ( e . g ., training and education , help desks ); and • Core practice management services such as provider enrollment , credentialing and contracting , claims submissions and adjudication , and patient health data systems . Specifically , the purpose of this RFI is to gather information about : • The types of services and operating models that exist in the market today ; • How other states and payers have structured TPA - like arrangements for nontraditional Medicaid providers ; and • Perspectives on how similar models and supports could be leveraged in Hawai ‘ i .

Hawaii

2026-04-08