Open data

Pilot

Every dataset behind these tools, as files you can download. Each file is built in your browser from the same data the pages show right now.

Terms

Free to use, including commercially, with credit: Source: Mohala Health Group Practice Tools, practice.hsios.org, checked [date].

Every record carries its own sources and verification gaps; check them before you rely on a record. These files describe what plans and agencies publish. They do not guarantee coverage or payment. No patient information is in any dataset.

How to cite: Source: Mohala Health Group Practice Tools, practice.hsios.org, checked [date on the file]. Use the date shown beside the dataset you downloaded.

Embed the finder on your site

Plans and products

Each Hawaiʻi health plan, its products, decision clocks, prior authorization channels, pharmacy rules, and appeal links.

Field guide

generated: The date the research file was compiled.
payers: One entry per plan, with its portal, phone, products, sources, and verification gaps. Each product holds its line of business, decision_clock, medical_pa, pharmacy_pa, and appeals.

Prior authorization rules

Whether each plan product requires prior authorization for each service category, who handles it, and the source.

Field guide

generated: The date the research file was compiled.
rules: One rule per product and category: status, handled_by, detail, source_url, and as_of.

Laws and decision clocks

Federal and Hawaiʻi rules that set prior authorization and appeal decision clocks, with citations.

Field guide

generated: The date the research file was compiled.
laws: One entry per law: jurisdiction, the plan lines it applies to, summary, clocks, effective date, citation, sources, and verification gaps.

Service categories

The service categories the finder uses, with what each one covers.

Field guide

categories: One entry per category: id, name, and what it covers.

APCM toolkit

Advanced Primary Care Management codes, rates, service elements, billing rules, and frequently asked questions.

Field guide

summary: A plain-language summary of the program.
effective: When the codes took effect.
codes: Each APCM code with its eligibility and national and Hawaiʻi rates.
service_elements: What a practice must provide.
consent: Consent requirements.
billing_rules: Billing rules for the codes.
concurrent_billing: Which other services may be billed in the same month.
rhc_fqhc: Rules for Rural Health Clinics and health centers.
add_ons: Behavioral health add-on codes.
cost_sharing: Patient cost sharing.
other_payers: What other payers publish about APCM.
faq: Questions and answers.
sources: The documents each record came from, with DIRECT or SECONDARY mode and retrieval date.
verification_gaps: What the published documents did not confirm. Check these before you rely on a record.

Rural Health Clinic pathway

Rural Health Clinic eligibility questions, requirements, Hawaiʻi context, payment, and steps to certification.

Field guide

summary: A plain-language summary.
questions: The eligibility screening questions and their pass, fail, or check results.
requirements: Certification requirements with citations.
hawaii: Hawaiʻi urban areas, clinic counts, and state contacts.
payment: How Rural Health Clinics are paid.
steps: Steps to certification.
sources: The documents each record came from, with DIRECT or SECONDARY mode and retrieval date.
verification_gaps: What the published documents did not confirm. Check these before you rely on a record.

Burden study framework

The framework for the administrative burden study: task types, roles, metrics, protocol, and national benchmarks. No study entries or results.

Field guide

framework_markdown: The study framework in plain language.
task_types: What counts as paperwork, with definitions and examples.
roles, payers, channels, outcomes: The choices a practice logs against.
metrics: How each result is defined and computed.
protocol: The two-week study steps.
privacy_rules: What the study never collects.
benchmarks: Published national figures with sources and years.
cms_0057f_metrics: The prior authorization metrics plans must report under CMS-0057-F.
sources: The documents each record came from, with DIRECT or SECONDARY mode and retrieval date.
verification_gaps: What the published documents did not confirm. Check these before you rely on a record.

ʻOhana transition kit

Dates, transition-of-care rules, checklists, and contacts for ʻOhana Health Plan leaving QUEST on 31 December 2026.

Field guide

generated: The date the research file was compiled.
summary: A plain-language summary.
key_dates: Transition dates and who they affect.
transition_of_care: What the new plan must honor and for how long.
member_choice: How and when members choose a plan.
claims_and_appeals: Claims and appeals for 2026 services.
ccs, dsnp: Behavioral health and Medicare changes.
remaining_plans: The four remaining QUEST plans and their contacts.
provider_checklist: Steps for practices, by month.
eligibility_check: How to check a patient's 2027 plan.
faq: Questions and answers.
membership: Published membership figures.
sources: The documents each record came from, with DIRECT or SECONDARY mode and retrieval date.
verification_gaps: What the published documents did not confirm. Check these before you rely on a record.

Confirmed plan changes

Plan rule changes a person confirmed against the plan's own document, with dates and what to do.

Field guide

id: A stable identifier for the change.
effective_date: When the change takes effect.
confirmed_on: When a person confirmed it.
payer_ids, product_ids, category_ids: The plans and services it affects.
title, before, now, what_to_do: The change in plain language.
source_title, source_url, source_mode: The plan document and whether it is DIRECT or SECONDARY.

ʻOhana code list

Procedure codes on ʻOhana Health Plan's published prior authorization list.

Field guide

product_id: The plan product the code applies to.
code, code_type: The procedure code and its code set.
description: The description the plan publishes.
requirement: Whether prior authorization is required, not required, or varies.
handled_by: The plan or vendor that reviews it.
effective_date: When the listing took effect.
source_url: The plan document.
verified_at: The date we checked it.

Other plans' code lists

Procedure codes from other Hawaiʻi plans' and vendors' published prior authorization lists.

Field guide

product_id: The plan product the code applies to.
code, code_type: The procedure code and its code set.
description: The description the plan publishes.
requirement: Whether prior authorization is required, not required, or varies.
handled_by: The plan or vendor that reviews it.
effective_date: When the listing took effect.
source_url: The plan document.
verified_at: The date we checked it.

Public JSON feed

Read the newest public version of one dataset by key. Read only, open to any site, no sign-in.

GET https://practice.hsios.org/api/public/datasets/{key}

Keys: payers, service_rules, laws, service_categories, apcm, rhc, burden, ohana_kit, change_log. The code lists are downloads only. The response carries key, source, version, verified_at, terms, and data.