Many HNS policies were developed by our CQI Committee, in conjunction with our managed care partners, to assist you in meeting the high standards in documentation, coding and compliance established for all healthcare professionals. It is not our objective to establish numerous or unnecessary rules and policies for our network providers, rather, to provide you with written policies that should be consistently followed to help you maintain the high standards that must be met by all participating providers and to help you protect your practices.
HNS reserves the right to periodically review and revise its policies.
HNS CORE POLICIES
1. SERVICES PROVIDED AND BILLED THROUGH HNS MUST BE DELIVERED IN THE MOST COST-EFFECTIVE MANNER.
2. ALL SERVICES BILLED THROUGH HNS MUST BE CONSISTENT WITH HNS POLICIES, HNS PAYOR POLICIES, THE PRACTICE GUIDES ISSUED BY THE STATE LICENSING BOARD IN THE STATE IN WHICH THE PROVIDER PRACTICES, AND ALL STATE AND FEDERAL STATUTES AND REGULATIONS.
3. ALL SERVICES BILLED THROUGH HNS MUST BE MEDICALLY NECESSARY, CONSISTENT WITH THE THE DOCUMENTED CHIEF COMPLAINT/CLINICAL FINDINGS, DIAGNOSES AND TREATMENT PLAN. (Exception: when maintenance/supportive care is covered by the payor.)
4. CLINICAL EXAMINATION FINDINGS MUST OBJECTIVELY SUBSTANTIATE THE MEDICAL NECESSITY OF SERVICES PROVIDED AND BILLED THROUGH HNS.
5. ALL SERVICES MUST BE PROPERLY DOCUMENTED, AND PROPERLY CODED WITH THE MOST ACCURATE CPT, HCPCS AND DIAGNOSIS CODES.
HNS Policies
Compliance to HNS and HNS policies and the terms of the HNS Practitioner's Participation Agreements is required for participation in the HNS network.
Should a violation occur or should HNS or a HNS contracted payor suspect a policy violation, HNS may take the following actions:
1. Require the provider to submit a signed attestation statement indicating he/she has
read, understands and agrees to comply with HNS and HNS payor policies.
2. Require the submission of a written corrective action plan.
3. Require the submission of copies of patient healthcare and financial records.
4. Require the provider to obtain additional continuing education
5. Place the provider on probationary Status
6. Terminate the Provider's Practitioner's Participation Agreement
7. Other such actions as deemed appropriate by the HNS Quality Improvement Committee
(CQI).
HNS Contracted Payor Policies
HNS is an intermediary between the contracted payors and the providers in our network. As such, our network providers must adhere to all policies established by the insurers and PPO's that you represent as a participating provider.
HNS Credentialing Policies
Because the responsibility of credentialing network providers has been delegated to HNS, HNS must adhere to all NCQA and URAC credentialing standards. In order to meet the high standards established by these agencies, network providers must comply with all HNS credentialing policies.
Board of Examiner Rules/Regulations/Practice Guides
All providers in the HNS network must comply with the rules, regulations and Practice Guides issued by their respective state boards.
Please be sure to review all information provided by your state licensing board, including practice guides, information regarding standard of care and scope of practice as well as all other rules and regulations established by your state licensing board.
PLEASE NOTE:
HNS providers must comply with all the requirements and policies referenced or included in the HNS Practitioner's Participation Agreement, and/or referenced or included in this website, provided they do not conflict with any state or federal requirements or policies of HNS contracted payors. However, these policies should not be followed if doing so could adversely affect the delivery of patient care.
Most HNS policies and payor corporate medical policies are listed in the blue box on this page. Please click on the appropriate heading to review the policy.
ADL Forms 
