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       Claims/Payment Processing


To assist you in understanding HNS' role in claims/payment processing, please review the information below.

 

  1. HNS does not adjudicate claims. 

  2. HNS cannot provide benefit/eligibilty information on your patients.  HNS has no role in applying co-payments/co-insurance and/or deductibles when your claims are adjudicated. The insurance companies/payors verify benefit and coverage information on each member before processing claims and adjudicate claims based on relevant policies as well as each member's coverage.

  3. HNS makes no decisions regarding the payment or denial of any services submitted to the payors through HNS. 

  4. All decisions are made by the insurance company, managed care organization and are subject to member eligibility, payor corporate medical policies and plan limitations. 

  5. Only the insurance company/payor determines whether services submitted on your claim are denied or paid.  If a service or procedure is denied, the basis for the payor's denial is shown on the EOB/NOP via the remark/reason code.

  6. HNS has no information regarding WHY a claim may be denied or paid by a payor, but we will gladly assist with understanding the reason codes on the EOB/NOP and, if applicable, we will contact the payor for clarification and assistance.

 
Prior to treatment, it is particularly important to verify any services that may be provided and to verify if those services are covered when provided by a chiropractor.  For additional information regarding this, please review the Non-Covered Services policy.

 

Please contact your HNS Service Representative for assistance regarding any "non-standard" or atypical service, prior to performing such service.

 

We want to help assure the prompt payment of your claims and to reduce your denials. Before transmitting your claims to the payors, we subject all claims to a series of edits designed to identify claims with errors or problems that will likely cause your claim to be denied. If our edits indicate that your claim is missing information needed for adjudication, we will notify you and advise you to correct the claim and resubmit.

 

After editing, the claims are separated into 2 groups: those that will be sent by paper (via the CMS 1500 claim form) and those sent electronically. Over 99% of HNS claims are sent electronically to the insurance company/payor. 

 

 

 

HNS’ Role In Electronic Claims Filing:

 

  1. At the end of each business day, an electronic file is created containing all claims entered into the HNSConnect® system during that day.

  2. That file is then electronically sent to the appropriate insurance or managed care company for adjudication. 

  3. Within 24 hours, HNS confirms the electronic file was received by the payor by obtaining an acknowledgment from the insurance company/payor that the file(s) was successfully transmitted and received for processing.  This assures us that all claims submitted to HNS were successfully sent to the insurance company or payor for adjudication. 

  
Claims requiring special handling and all claims with attachments, (such as secondary claims with primary EOB'S attached) are keyed into our system and sent by paper, via US Mail, directly to the insurance company/payor for adjudication.

 

HNS has no more involvement in the claims processing process until your claim is adjudicated by the payor. Once the claim is adjudicated by the payor, the payor sends any remittance due to the provider to HNS, together with the EOPs.

 

 

 

HNS’ Role In Issuing EOB/NOPs:

 

  1. HNS receives payor remittances and EOPs on a daily basis. 

  2. We post all monies received each day under the appropriate HNS provider's name, (much like you post payments to your patient accounts).

  3. We store all EOP's that were included with the remittance in each provider's electronic file. 

  4. On the 10th, 20th (or next business day) and on the last business day of each month, we electronically transfer any monies due you and upload your EOPs to the secure portion of our website. 

 


NOTE: Due to processing requirements, payments received from a payor in the 24 hours preceding the electronic funds transfer (EFT) may not be issued until the next scheduled EFT. 

 

 

You can be confident that if we receive your claims, they will be sent to the appropriate insurance company or payor for adjudication in a timely manner.  However, if you do not receive correspondence from a payor for a particular claim within 60 days, we recommend that you contact HNS to determine if your claim was received by HNS.  While HNS can inform you of the date the claim was sent to the insurance company or payor, we have no information as to the status of your claim once it has been sent for adjudication.  However, if you need our assistance, we will be happy to trace the claim for you.

 

While we have no role in the adjudication process, we want to help assure you are promptly paid for the covered services you provide and bill through HNS.  Questions regarding the status of any claim submitted through HNS should be faxed to HNS on a HNS Fax Inquiry Form.