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/  Medicare Advantage Network

Medicare Advantage Network

We serve members through many different plans, including HMSA’s Akamai Advantage plan members. This gives you the opportunity to see more patients and to provide much-needed dental care to seniors.

Frequently Asked Questions

Am I in-network for HMSA’s Akamai Advantage Plans?

Effective 1/1/22 we created the HMSA Medicare Advantage network. You can verify your current participation status with this network by using our Find a Dentist portal. Simply enter the dentist’s name, select “All Islands,” and choose the according “Akamai Advantage (Dental)” plan from the drop-down menu under “Select Plan Name.”

How do I verify my patients’ Akamai Advantage plan status?

Members will present to your office with an HMSA Akamai Advantage ID card. Sample ID card for each plan available here.  To verify benefits, please refer to MyPatientsBenefits or contact Customer Service at 808-948-6000 Option 3.

If a service is not covered by a member’s Akamai Advantage benefit plan, you are required by law to inform members in writing and in advance of treatment, outlining their financial responsibility.

Where can I find Akamai Advantage plan benefit details?

Please contact Customer Service at 808-948-6440 for assistance with benefit questions regarding the Akamai Advantage plans.

How am I reimbursed for Akamai Advantage plans?

Participating providers in the Medicare Advantage network are reimbursed using the Medicare  Advantage fee schedules, located on hmsadental.com. Click here for current MA fee schedules. Members who choose to see a non-participating Medicare Advantage network provider will be directly reimbursed at 60% of the eligible charge for covered services.

What if I have opted out of Medicare?

If you have opted out of participation with Medicare and/or the Centers for Medicare & Medicaid Services (CMS), as of Jan. 1, 2022, the Medicare opt-out status no longer applies to supplemental dental services covered by dental insurance companies through Medicare. Medicare Advantage Network providers and/or Akamai Advantage plan patients will now be able to receive payment for services even when the treating provider is opted out of Medicare.

Do I need to do any special training for participation with the Medicare Advantage network?

Yes, all providers who participate with Medicare Advantage should complete fraud, waste and abuse training annually with their staff. This training is provided by the Centers for Medicare & Medicaid Services (CMS) to access it:

  • Visit CMS’s training site
  • Go to “Fraud and Abuse-related Resources”
  • Click on “Fraud and Abuse Educational Products”
  • Follow the instructions for accessing the web-based training and downloadable PDF versions

Where can I find more information?

You can find more information, including ID card examples, in our Medicare Advantage Dental Manual.