Health Network Solutions, Inc. : Remittance

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Remittance from HNS

POSTING HNS REMITTANCE

For all contracts, payment (remittance) is sent from the payor to HNS. HNS disperses the appropriate payment to your office via electronic fund transfers (EFT). Your EOBs and HNS Remittance Summary form(s) can be downloaded from the secure portion of this website.

HNS issues bulk provider payments on the 10th, 20th and 30th of each month, or the next business day. All monies received by HNS during the check cut periods are sent via electronic fund transfers (EFT) on the next scheduled bulk provider check cut date..

In order to assure that your patient's accounts are current and that your accounts receivable figures are accurate, HNS providers are required to post all EOB/NOB within 30 days of receipt.

If there are ANY inconsistencies in the amount actually paid by HNS, and the amount shown on your EOB/NOP as the amount actually due you from the payor, OR if the amount shown on your provider statement does not match the amount of your HNS check, you must notify HNS within 10 days.

Underpayments.

If a claims or claims were adjudicated incorrectly by the payor, and the EOB/NOP reflects less than the contacted allowable, please contact your HNS representative and she will assist you in resolving the issue(s).

Overpayments

If a claim or claims were adjudicated incorrectly and you received payment for services you did not provide, or received payment at higher than the HNS contracted allowable, you must contact HNS immediately to arrange to for the prompt repayment of those funds. HNS will provide instructions regarding how the refund(s) will be handled.

HNS reserves the right to determine how refunds/overpayments will be repaid.

HNS may:

1). Require you to submit a certified check or money order, payable to HNS, for the amount of the overpayment . If a refund is required by HNS the refund must be submitted to HNS within 10 days of the date the refund was requested by HNS

OR

2) Recoup, or allow the payor to recoup, the amount of the overpayment from future HNS checks. If the funds are to be recouped from future checks, HNS reserves the right to recoup funds from any and all providers in a group practice who are receiving payment under the same EIN.

POSTING HNS ADMIN FEE

When posting HNS payments, please remember that you do NOT post the HNS admin fee to your patient's accounts. (Please see Posting Instructions below.) Also, please remember that HNS does not adjudicate claims. We do not make any determination regarding the payments or denials of your services. All such decisions are made by the payor, not HNS. The "remark code" shown on the EOB for each service rendered represents the payor's explanation for the action taken on the particular CPT code.

PLEASE REMEMBER, YOU ARE REQUIRED TO KEEP ALL EOB’S RECEIVED WITH YOUR HNS REMITTANCE FOR 7 YEARS.

Your HNS check packet will include the following

1. HNS Remittance check (if applicable)

2. Provider Statement - this is a confirmation page of the total amount of the check you received from HNS.

3. Remittance Summaries with EOB's - Your Remittance Summary is a summary of the total amounts included on each EOB, the HNS admin fee and the actual dollar amount paid to you in your HNS check.

4. Important notices for you and your billing staff regarding HNS contracts and other important information from the payors, such as a request for additional information regarding a specific claim will be faxed to your office. Please be sure to pay close attention to any HNS notices and make sure it is distributed to appropriate staff members.

POSTING INSTRUCTIONS FOR YOUR

HNS REMITTANCE

If you are a NEW HNS provider, please call us when you receive your first HNS remittance and we will assist you with any questions you may have about properly posting your HNS remittance.

Post to your patient's accounts using ONLY the EOB/NOP. (Please note, the HNS admin fee should never be posted to your patient account. See the policy on Balance Billing).

Make certain the amount you post to each patient's account is exactly the amount shown as "amount paid" on the EOB for the patient.

The difference between the "billed charges" and the "contracted charges" on the EOB should be adjusted from each patient's account as a contractual adjustment/write-off. You cannot "balance bill" the patient for this amount. The correct amount to write off as your contractual adjustment can normally be found in the "disallowed amount" column on the EOB.

Don't forget to post ZERO dollar payments ($0.00 dollar amounts paid) when no payment was made by the insurance company and transfer this amount to "patient responsibility" when appropriate.

Once you have finished posting each EOB, check to make sure the total amount you have just posted to each of your patient's accounts in your practice management software system is EQUAL to the total amount of the EOB.

Next, compare the amount you posted to your patients' accounts in your practice management software to the TOTAL column of the "Paid by Ins Co" section on the Remittance Summary that accompanies each EOB. If you correctly posted to your patients' accounts, these two numbers will be the same.

Always post ALL of your HNS checks to your patients' accounts BEFORE SUBMITTING REQUESTS FOR CLAIMS TRACING!

The HNS administrative fee should never be posted to the patient’s account. Always post the “paid” amount shown on your EOB when posting to each patient’s account.

Should you receive a payment for a member that is not your patient, use your HNS Fax Inquiry Form and fax a copy of the Remit Summary, a copy of the EOB (circle the patient’s name) and HNS will adjust on your next HNS check.

HNS providers are required to post all EOB/NOB within 30 days of receipt.