tracelogoRB Why do I pay an administrative fee to HNS?

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HNS wants you to understand why you pay an “admin fee” to HNS.

The HNS Administrative Fee is 
not a charge for processing claims.  
HNS contracts with individual healthcare professionals, and with insurance and managed care companies who utilize our network as their preferred provider organization (PPO).

Patients who have insurance with HNS contracted payors often choose to seek care from an “in-network” provider.  The names of the “in-network” providers are listed on the payor websites and in the PPO Provider Directories issued to employees promoting steerage of new patients to our healthcare professionals.

 

HNS does not receive any compensation from the insurance companies and managed care organizations that contract with HNS.  The HNS admin fee provides the network with revenue to fund the cost of the services and administrative functions we provide. Some of these services include:

      • Network Development
      • Credentialing / Recredentialing
      • Contract Negotiation
      • Quality and Utilization Management
      • Clinical Resources and Support
      • Central Claims Administration (central processing of your claims to the contracted payors and disbursement of monies back to each provider)
      • Continuing Education
      • Electronic claims filing to improve efficiency and faster payments
      • Administrative Support Services, including HNS Service Representatives, to assist in resolving claims/payments issues.
      • Electronic Funds Transfer
      • HIPAA ERA 835 file for automated payment posting
      • Educational Website 


The HNS Admin Fee is calculated against the allowable amount on each member’s EOB. Specifically, the admin fee is charged against the sum of the deductible amount, the copayment/coinsurance amount, plus the amount paid by the health plan, for each service line on the EOB.

 

 

NOTE:  “The 'allowable amount' is the contracted rate that the payor intends for the provider to collect for the service provided that is represented by a particular CPT or HCPCS code. 

 

 Remember that all members’ insurance plans have one or more of the following:

 

      • Co-payment
      • Co-insurance
      • Deductible


When the claim is adjudicated by the payor, the EOB and payment are sent to HNS; most often in a large bulk payment and EOB file.  HNS then tracks and allocates all monies and EOB’s received from each insurance company, for each HNS Healthcare Professional, and provides the EOB and payment to each provider on the next scheduled HNS bulk provider payment date.

 

HNS does not take an admin fee when, per the EOB, the provider will not receive ANY payment for his services.  HNS ONLY receives payment for services for which the provider will be paid  (whether the amount is collected as a co-payment, deductible, co-insurance or from the insurance plan).

 

 

NOTE:  HNS Utilizes Banker’s Rounding in calculating the HNS Admin Fee.

 

 

In calculating the HNS Admin Fee, HNS utilizes Banker's (or Statistician’s) Rounding. In use by most banking and financial institutions, this type of rounding produces results that on average, round numbers down as often as they are rounded up. In any large set of numeric data, there is a fairly equal distribution of even and odd numbers. Unlike conventional rounding, banker’s rounding prevents data from being skewed upward and also prevents the data from being skewed downward. Banker’s rounding is considered the most unbiased form of rounding.

 

HNS’ software rounds based on the number in the 3rd decimal place.

 

In Banker’s Rounding

      • If the third decimal is 0 - 4, the number is rounded DOWN. 
      • If the third decimal is 6 - 9, the amount is rounded UP.
      • If the 3rd decimal is 5, the amount is rounded to the nearest EVEN cent.

 
The HNS Admin Fee is applied to the “allowable” amount, and the allowable amount is calculated per service line on each EOB.  Remember, the allowable is the sum of the amount paid by payor, co-payments, co-insurance/deductibles owed by the patient.  

 

The total admin fees shown on a particular HNS Remittance Summary are the sum of the admin fees for all service lines on the EOB's associated with that remittance summary.

 

 

Examples of Banker’s Rounding: 

    1. 7.644 would round to 7.64 (The 3rd decimal is a 4 so number is rounded DOWN)
    2. 7.647 would round to 7.65 (The 3rd decimal is a 7 so number is rounded UP)
    3. 7.645 would round to 7.64 (The 3rd decimal is a 5 and the nearest EVEN cent would be 7.64, so number is rounded DOWN)
    4. 7.635 would also round to 7.64 (The 3rd decimal is a 5 and the nearest EVEN cent would be 7.64, so number is rounded UP)