HMSA
HMSA is a payer organization operating in California, Hawaii, and Nevada. For an ASC, what matters isn't the logo. It's how HMSA pays: where it runs rich, where it runs thin, and how its reimbursement compares with peer plans for the same procedures.
Pilot Analysis
Get the complete HMSA analysis
Tell us where to send it. Our team will prepare an analysis of HMSA covering rates by code, market position, and underpaid areas, and email it to you within 5-10 business days. Need it faster? Book a demo.
What Insights reveals
How HMSA pays
See how HMSA reimburses across procedures and markets, benchmarked against the peer plans competing for the same cases. Not a raw rate sheet, a read on where it sits.
Geographic footprint
HMSA's presence spans California, Hawaii, and Nevada. See where it concentrates and how that shapes the markets you compete in.
Peer position
Put your own position next to the benchmark for HMSA and bring the gap to your next contract conversation.
Specialty mix
Understand which procedures and specialties drive HMSA's volume, so you know where a rate change moves the needle.
Whether you're an ASC benchmarking a contract or a provider team looking HMSA up, DataLily AI maps how it reimburses across procedures and markets, and where your own rates sit against the peer benchmark.
Reference
Working with HMSA
- Payer ID
- 100937 is the EDI identifier used to route electronic eligibility checks (270/271), claim-status inquiries (276/277), and claims to HMSA through a clearinghouse.
- Eligibility verification
- Coverage and benefits for HMSA members are verified before the date of service, through a clearinghouse using payer ID 100937or through the payer's provider portal.
- Prior authorization
- Requirements are set per plan and per procedure. Confirm whether an authorization is required with HMSA directly before the date of service.
Book a demo: pick a time
A 15-minute walkthrough of HMSA the way it pays.
- What is HMSA's payer ID?
- HMSA's electronic payer ID is 100937. ASC billing teams use it to route eligibility checks (270/271), claim-status inquiries (276/277), and electronic claims to HMSA through a clearinghouse.
- How do ASCs verify eligibility for HMSA members?
- Eligibility and benefits for HMSA members are verified before the date of service, either electronically through a clearinghouse (a 270/271 transaction using payer ID 100937) or through the payer's provider portal.
- Does HMSA require prior authorization for ASC procedures?
- Prior-authorization requirements for HMSA are set per plan and per procedure. Confirm whether an authorization is required with HMSA directly before the date of service.
- What type of payer is HMSA?
- HMSA is a payer organization operating in California, Hawaii, and Nevada.
- How does HMSA compare with other payers for ASC procedures?
- Ask Rose and you get a plain-language read on where HMSA pays above or below peer plans for your top procedures, charted, and ending in a recommendation you can take into a contract conversation.
- Is HMSA paying my ASC below market?
- Put your own HMSA contract next to the peer benchmark in DataLily AI and you'll see the gap by procedure and market, the fastest way to know whether you're leaving money on the table.