tracelogoRBFrequently Asked Questions - Billing/Claims

 

 

Have you just hired a new billing CA?  HNS provides free orientation and training for your billing staff. Training is designed to improve efficiency and productivity in your practice and to help you improve compliance to policies, laws and regulations, reduce your claim denials and improve your cash flow. Just call your HNS Service Representative to schedule.



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1.    Where do I send my HNS claims?

 

All primary claims for HNS contracts must be sent electronically to HNS via HNSConnect® or via Office Ally. (HNS does not accept claims from any other clearinghouse.) 

 

If you need to submit a paper claim, these claims must be sent using the standard CMS 1500 claim form, with any attachments, and must be sent directly to HNS or the claim will not be processed correctly. Claims that will be sent to HNS on paper CMS 1500 claim forms are as follows:

  • Secondary claims
  • Corrected claims
  • Claims w/Attachment(s)
  • A few CIGNA Third Party Administrator (TPA) claims

 

 

Please remember to ignore ALL other instructions from payor representative concerning where to send claims. HNS claims that are sent directly to the insurance company will result in a denial of your claim or payment at the out-of-network rate.

Instructions from HNS SUPERSEDE ALL instructions from insurance companies regarding WHERE TO SEND CLAIMS!

 

 

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2.   Why do I send my claims to HNS?

 

To assure our managed care partners that you are a participating provider, entitled to “in-network” benefits, your claim must first be processed by HNS, before being sent to the payors for adjudication.

 


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3.    What claims do I send to HNS?

 

If you are a NORTH CAROLINA provider, you should send claims to HNS for ALL covered services provided for the following HNS contracts:

 

  • Blue Cross and Blue Shield of North Carolina (BCBSNC)
    • All PPO for in-state and out-of state BCBS
      NOTE:  In-state BCBSNC Blue Medicare plans are not filed to HNS and claims should be sent directly to BCBSNC.  Out-of state BCBS Medicare Replacement plans are filed to HNS as long as the back of the ID card states that "Claims should be filed to your local BCBS."
    • NC State Health Plan
    • Federal Employees Plan
    • BCBS Medicare Supplemental Plans 
  • CIGNA Healthcare
  • HealthTeam Advantage
  • HealthSpring Medicare Advantage
  • Liberty Advantage (effective 1/1/2018)
  • MedCost

  

If you are a SOUTH CAROLINA provider, you should send claims to HNS for ALL covered services provided for the following HNS contracts:

 

  • CIGNA Healthcare
  • HealthSpring Medicare Advantage
  • MedCost
  • Absolute Total Care
  • Select Health of South Carolina

 

 

 

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4.    What are BCBSNC Blue Medicare Supplemental plans?  Are these filed to HNS?


BCBSNC Blue Medicare Supplemental plans are policies that may cover the remaining member expense that Medicare (or any replacement plan) does not pay; such as any co-insurance and/or deductible.  Blue Medicare Supplemental plans process per Medicare's guidelines and only pay for services that are covered by Medicare.

 

Example:  Prefixes for BCBSNC Supplemental Plans that must be filed to HNS:  YPZJ or YPZW

 

All BCBS Medicare Supplemental plans are filed through HNS regardless if they are in-state or out-of-state plans.  Please print the supplemental claim, mark it "COB" and then fax or mail it to HNS along with the primary Medicare EOB to ATTN:  HNS Claims Dept.

 

 

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5.    What if I am unsure about where to send a claim?

 

Use your HNS Fax Inquiry Form and fax a clear, legible copy of the front and back of the patient’s insurance card to HNS.  We will review the card and promptly fax back your answer.

 

NOTE:  Please lighten all CIGNA HealthCare ID cards prior to faxing them to HNS. Their background color blackens the entire card when faxed if not lightened first.

 

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6.   May I send my claims electronically to HNS?

 

Yes, HNS providers are required to send all primary claims electronically to HNS in the required HIPAA compliant 837p 5010 format. These claim files may be submitted to HNSConnect directly from your billing software OR via Office Ally.  (HNS does not accept claims from any other clearinghouse.)


Exceptions:  Secondary claims with primary EOB's, corrected claims, and any claim with an attachment.  These claims must be sent via “paper” on CMS 1500 claim forms to HNS.

 


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7.    Does HNS have a payor ID number?

 

Yes.  HNS has payor ID number but these are ONLY for use in claim files that you are submitting to HNS via Office Ally.

 


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8.    Who do I call to verify benefits?

 

Where and how member benefits are verified depends on the member’s insurance.  Please refer to the phone number on the back of the member ID card for information regarding where to verify benefits.

 

PLEASE REMEMBER that Payor Corporate Medical Policy for Chiropractic takes precedence over any information given to you by payor representatives.  Please contact your HNS Service Representative for assistance in determining if the service is consistent with Corporate Medical Policy.

 

NOTE:  BCBSNC and CIGNA HealthCare’s Corporate Medical Policies for Chiropractic can be found on the payor web sites and on this website under "HNS/Payor Policies".  Also note, members of the Federal Employee Plan are NOT subject to the BCBSNC CMP.  Providers should contact the FEP plan to verify what services are covered chiropractic benefits.

 

 

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9.    Why can’t HNS verify benefits or eligibility?


HNS is not the insurance company; therefore, we do not have access to such information regarding individual members and dependents.

 

 

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10.   When verifying benefits, I am told that I am not an in-network provider. Why does this happen and what
        should I do?

 

Insurance companies have HNS participating providers listed in their system under HNS’s federal tax number or NPI number. If you provide your own NPI or EIN, you will not be recognized as a HNS “in-network” provider.  

 

When calling the insurance companies, if you are told that you are not listed as a participating provider, use the HNS Federal Tax ID number or NPI number, rather than your tax number or NPI number.  Contact your HNS Service Representative for more information about the use of the HNS tax number and NPI number.

 


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11.  Does HNS determine what is paid or denied on my claims?

 

No, HNS makes no decisions regarding the payment or denial of your claim. HNS does not adjudicate any claims. Claims are adjudicated only by the payor.  If you do not understand or agree with a denial or with a payor’s remark code on the EOB (the remark code indicates the reason for the payor’s action on each CPT code), please contact your HNS Service Representative for assistance.

 

 

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12.  How long do I have to file a claim?

 

HNS requires you submit all primary claims within 15 days from the date of service and for secondary claims, within 15 days from receipt of the primary EOB.

 

However, if you discover that a claim was never submitted or the insurance company states they have not received your claim, you may have between 90 days and 12 months from the date of service to file a claim, depending on the specific payor timely filing requirements.  

 

When verifying patient benefits, please remember to ask the payor about their timely filing policies. Claims submitted past payor "timely filing" requirements are routinely denied by the insurance companies for “untimely filing.”

    • NC Providers:  Based on North Carolina laws, BCBSNC and CIGNA reserve the right to deny claims that are submitted more than 180 days from date of service.

 

NOTE:   For out-of-state BCBS claims, because you are in-network through BCBCNC, the timely filing policy for BCBSNC  supersedes the home plan’s timely filing.  

 

    • SC Providers:  Based on South Carolina laws, CIGNA reserves the right to deny claims that are submitted more than 90 days from date of service.

 

 

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13.  Why does HNS return certain claims to my office?

 

When HNS determines a claim is missing necessary information for correct adjudication OR if a payor rejects the claim back to HNS, we return the claim to you so you can correct it. HNS provides this service to reduce your denials and to assist you in getting your claims paid in a timely manner.

 

If you filed the claim electronically through HNSConnect®, you will receive an Electronic Claim Error Report. If you filed a paper claim, you will receive a HNS Claim Return Form. Each form will note the specific error(s) on the claim submitted to HNS.

 

 

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14.  If HNS sends me a HNS Electronic Claim Error Report or returns a claim to me with a HNS Claim Return
        Form, what do I do after I make the appropriate correction(s)?

 

If you receive a HNS Electronic Claim Error Report, make the necessary correction(s) and resubmit the claim to HNS as a paper claim on a CMS 1500 claim form.

 

If you receive a HNS Claim Return Form with your paper CMS 1500 claim form, make necessary correction(s), staple the claims return form to the corrected claim and mail the claim back to HNS and we will forward on to the payor for adjudication. For proper filing of your claim, it is imperative that you return the HNS Claims Return Form when you resubmit your claim to HNS.

 

NOTE:  Claims returned to you from HNS should NOT be resubmitted as "CORRECTED" since it has not yet been sent to the payor.  Only claims that have been processed by the payor and for which you have received an EOB/NOP indicating the claim has been processed should be marked as "CORRECTED".

 

 

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15.   My software shows that I have electronically submitted a claim to HNS, but the payor has not received it.  
        Where
 can it be?

 

When filing your claims electronically on HNSConnect®, the system performs custom edits on your electronic claims and if any errors are found, they will appear after 24 hours.  It is very important to check the status of your claim file and correct any claim(s) that contain errors after the 24 hour processing time.

 

If a claim has an error, it is not submitted to the payor until all errors have been corrected.  If you have submitted a claim electronically to HNS, but the payor has not received it, the claim is most likely in an error status on HNSConnect®.  It must be corrected and resubmitted electronically. Please remember to make the necessary changes in your practice management software so future claims will not error out for the same reason on HNSConnect®.

 

If you have any questions about how to check the status of a batch file, please call your HNSConnect® Representative for assistance.  If you are submitting your claim file to HNS via Office Ally, Office Ally will notify you, via email,  if any claims cannot be submitted to the payor.  Those claims will need to be corrected and submitted to HNS as paper claims on the CMS 1500 claim form.

              

 

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16.  If I accidentally submit a claim file on HNSConnect®, is there any way to stop it from going to the payors?

 

No. Once the claim file has been submitted, processed, and is clear of any errors, HNSConnect® will automatically submit your clean claim(s) to the payor(s).

 

 

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17.  If I receive a “BCBS Error” in HNSConnect®, what is wrong with my claim and how do I correct it?

 

If you receive a “BCBS Error” for a claim in HNSConnect®, that means BCBSNC found a discrepancy in the patient's ID number, patient name and/or the patient date of birth. Be sure to verify ALL patient information and make the appropriate corrections in order to resubmit the claim. Please remember to make the necessary changes in your practice management software so future claims will not error out for the same reason on HNSConnect®.

 

 

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18.  When I resubmit a claim that was previously filed incorrectly, often I receive an EOB stating this is a
        duplicate claim. Why 
does this happen and what should I do?

 

Many insurance companies have edits intended to prevent duplication of payments for the same dates of service. These edits check for previously submitted dates of service and often will “kick out” a claim for a date of service that is already in their system. 

 

If this occurs, you will need to regenerate a new CMS 1500 claim form, attach BOTH of the EOBs (the first EOB showing a denial of the original claim and the second EOB showing denial as a duplicate claim) and send to HNS.  HNS will forward to the payor for proper adjudication.

 

 

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19.  What if I am not sure what to put in boxes 11
, 11b, and 11c on the CMS 1500 claim form?

 

Use your HNS Fax Inquiry Form  and fax a clear, legible copy of the front and back of the insurance card to HNS and we will respond with the information you need to complete these boxes. 

 

For a MedCost member’s claim, refer to the MedCost Physician Reference Guide for this information.

 


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20.  What is the MedCost Physician Reference Guide and how do I receive it?

 

The MedCost Physician Reference Guide provides listings of MedCost employer groups and payors.  It contains important information needed to complete boxes 11 and 11c of your CMS 1500 claim form as well as important phone numbers for most MedCost payors. It is updated monthly by MedCost. 

 

Please click here for instructions on how to obtain the MedCost Physician Reference Guide.  It is a valuable resource.

 

 

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21.   When should I complete box 14 (date of current illness or injury) on the CMS 1500 claim form?

 

Box 14 must be completed whenever you use a "sprain/strain" diagnosis code or if any boxes within box 10 are marked “yes”.

 

 

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22.  What do I put in box 24J on the CMS 1500 claim form?

 

Box 24J should contain the rendering provider's Type I NPI number.

 

 

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23.  Is “Signature on file” acceptable in box 31 of the CMS 1500 claim form?

 

No. The provider’s full legal name must always be in box 31 and should be computer generated or typed so it is clearly legible.

 

For paper claims, “Signature on file” is not acceptable and will result in your claim being returned for correction. Claims sent electronically on HNSConnect® will error back for ’Physician Name.’  

 

 

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24.  What do I put in boxes 32a and 33a on the CMS 1500 claim form?

 

If you have a Type II NPI number, this number must be placed in both boxes 32a and 33a.  If you do not have a Type II NPI number, you may use your individual Type I NPI number in these boxes.

 

 

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25.  If I have other problems or questions about a claim, what should I do?

 

Complete the HNS Fax Inquiry Form and fax your question or concern to your HNS Service Representative for assistance.

 

Please include the following information:

 

  • Patient Name

  • Date of Service (Please do not send a date range - note each date of service)

  • Insurance Plan

  • Patient Date of Birth

  • Patient ID number

  • Please include your specific question or details relating to the claim

 

 

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26.  How do I know if HNS has received my claim?

 

If you submitted the claim electronically, log in to HNSConnect® and check the status of the claim file batches. If your claim file(s) have no errors, you can search for the individual claim to verify it was submitted.


If you have checked HNSConnect® and found that you have submitted the claim electronically and it has no errors OR you filed the claim to HNS on a paper CMS 1500 claim form, complete theHNS Fax Inquiry Form,  and include the name of the patient, the ID#, patient date of birth, the name of the insurance company, and the date of service, then fax to HNS. We will research and respond within 3 business days.

 

 

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27.  When should I check the status of a claim?

 

For BCBSNC claims, please allow 30 business days from the date the claim was submitted to HNS before tracing.  For other insurance plans, please allow 45-60 business days from the date the claim was submitted to HNS. Please remember to post all remittances from HNS PRIOR to requesting any claim be traced.

 

If you have not received an EOB/NOP or a request for additional information for a claim submitted more than 120 days ago, please contact your HNS Service Representative to determine if HNS received your claim.  Once this is determined, we will assist you with instructions for refiling the claim. 

 

Please do not resubmit a duplicate claim until you have checked with your HNS Service Representative to determine if you claim is pending at the payor. 

 

 

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28.  Should I use the HNS Fax Inquiry Form to check the status of a claim?

 

Yes.  All requests to check the status of a claim must be submitted via theHNS Fax Inquiry Form. We will respond to your inquiries within 3 business days.  

 

Please include the following information:

 

  • Patient Name

  • Date of Service (Please do not send a date range - note each date of service)

  • Insurance Plan

  • Patient Date of Birth

  • Patient ID number

 


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29.  I traced my claim with the insurance company and they stated the claim had been paid.  However, we have
        not received the
 payment/EOB yet. What do I do?

 

First, make sure all payments received from HNS have been posted to your patient’s accounts. If you are still unable to locate the payment, use theHNS Fax Inquiry Form,   mark the appropriate box, and fax to HNS along with the required information. HNS will investigate and respond within 3 business days.

 

 

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30.  Sometimes, the EOB will reflect “out-of-network” benefits. I am a participating provider with HNS. Why does
        this happen?

 

Claims sent by your office DIRECTLY to the payor are routinely denied or processed at out-of-network benefits.  This is the most common reason for receiving out-of-network benefits and avoiding this will save you time and money. In order for you to receive in-network benefits, HNS claims must be sent directly to HNS.

 

 

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31.  What do I do if I receive “out-of-network” benefits?

 

First, generate a new CMS 1500 claim form for that date of service and mark the claim "CORRECTED CLAIM." Make a copy of the EOB showing the out-of-network payment for that date of service and staple to your new CMS 1500 claim form. Please mail to HNS for processing.

 

Be aware that this second submission often results in a denial for “duplicate” submission of a claim and can take months to be correctly processed.  Always send your claims for HNS contracted payors to HNS, not the insurance company!

 

 

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32.  What do I do if I receive payment for a member who is not a patient in our practice?

 

Please immediately fax a completedHNS Fax Inquiry Form, along with a copy of the remittance (circle patient’s name), and the EOB. HNS will make an adjustment on your next check.

 

 

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33.  How do I post the HNS Admin Fee?

 

The admin fee should never be posted to your patient’s account.  When posting payments to your patient’s account, post exactly the amount shown on the EOB as the “paid” amount.  You do not post the HNS Admin Fee.  Please contact your HNS Service Representative and we will assist you with the proper posting of claims that are processed through HNS.

 

 

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34.  How often do we receive remittances from HNS?

 

HNS issues Electronic Fund Transfers (EFT) on the 10th, 20th, and 30th of each month (or the last business day of the month/next business day following these dates.)

 

 

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35.  Does HNS notify us when there is a change involving one of the HNS contracts?


Yes! There are three (3) ways we notify our providers of important news and updates.

 

  • Email notifications

  • Via U.S. Mail 

  • The Current News section of this web site

 

 

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