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Form 1139 Instructions 2014-2023
APRNs, Physician Assistants, RNs, and
Dentists. Please submit a money order or cashiers check for $500 when submitting your
application, payable to:
State Director of Finance
c/o Med-QUEST Division
Health Care Services Branch, Provider Enrollment
P. O. Box 700190
Kapolei, Hawaii 96709-0190
MANAGED CARE
MQD has been able to obtain a waiver from some of the requirements for providers of managed
care health plans. Managed care health plans will perform credentialing of providers. The MQD
is able...
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