tracelogoRBSimplifying the credentialing process.

 

HNS is responsible for credentialing all network healthcare professionals and our credentialing program requirements are consistent with NCQA, URAC and applicable regulations. Please contact us if you have any questions about our credentialing program.

 

Click below for quick links:


Addition of an Associate

 

Credentialing

 

Re-credentialing

 

Credentialing Committee Meeting

 

Provider Rights

 

HNS Credentialing Policies 

  

 

  tracelogoRBAddition of an Associate to your practice

 

Thinking of adding a new associate to your individual or group practice?

 

New Associates Not Yet a Member of the HNS Network:
If your new chiropractic associate is not yet a member of HNS, please contact your HNS Service Representative so that we may assist you with credentialing the provider as soon as possible.

Please remember, to prevent confusion for members seeking care from an "in-network" provider, all chiropractors practicing at the same location must participate with HNS, or none of the chiropractors at the location may participate with HNS.  This includes providers in a group practice filing claims under the same EIN as well as independent contractors practicing in another physician's office.

 

Pre-application Requirements: Prior to applying for participation in the HNS network, health care professionals must first obtain their:

1.  License number from the appropriate Board of Chiropractic Examiners

2.  Individual Type 1 NPI, and if applicable, a Type 2 NPI number

3.  Medicare PTAN number

4.  SC Medicaid number (for SC providers)

5. Malpractice Insurance Certificate (minimum of $1 million/$3 million)

 

New Associates Already Part of the HNS Network:
If your new associate is already a member of the HNS network, you must complete and submit the HNS Notification of Provider/Practice Change Form so that we may link this provider to your practice.  This, and all other HNS forms, can be found under the HNS Forms tab of this website. 

  

 

  tracelogoRBCredentialing

 

HNS is responsible for the credentialing and re-credentialing of all network providers. Our credentialing program is designed to meet both NCQA and URAC’s stringent credentialing requirements, as well as state and federal laws.

 

Subject to HNS business, geo-access needs, HNS is an open panel network. Providers who are interested in becoming participating providers with HNS should contact HNS and request an application at (888) 712-6488 or you may call (877) 426-2411, extension 128.

 

Pre-application Requirements: Prior to applying for participation in the HNS network, health care professionals must first obtain their:

1.  License number from the appropriate Board of Chiropractic Examiners

2.  Individual Type 1 NPI, and if applicable, a Type 2 NPI number

3.  Medicare PTAN number

4.  SC Medicaid number (for SC providers)

5. Malpractice Insurance Certificate (minimum of $1 million/$3 million)

 

Credentialing is the initial process through which HNS collects, reviews and verifies specific criteria and pre-requisites in order to determine a provider’s eligibility for participation with HNS. The credentialing process for a new provider takes 4 to 8 weeks, once the application is received by HNS. The application is then reviewed and the process of verification of information begins.  Incomplete applications are returned to the provider with a letter outlining what is needed for the application to be considered complete. For each applicant, HNS will obtain additional information from the appropriate malpractice carrier, the appropriate state licensing board, The National Practitioner Data Bank (NPDB) and/or other sources as may be required. 

  

 

  tracelogoRBRe-credentialing

 

Re-credentialing is the process through which HNS collects, reviews and verifies specific criteria and pre-requisites in order to determine a provider’s continued eligibility for participation with HNS.

 

Re-credentialing is required at least every three years. A re-credentialing application will be sent to each participating provider at least thirty days prior to the expiration of the provider’s last credentialing date. The provider must complete and return the re-credentialing application and all documents by the requested date for continued network participation with HNS. Failure to re-credential by the required due date can result in termination of the HNS provider contract.

 

To simplify the re-credentialing process, we have completed parts of the re-credentialing application for you. When you receive your re-credentialing application, it is very important that you carefully review each section to assure the accuracy of the information before submitting to HNS. If any of the pre-filled information is incorrect, please provide correct, current information.

 

If you have any questions regarding how to complete your re-credentialing application, please contact us at (888) 712-6488 or (877) 426-2411, extension 128.

  

 

  tracelogoRBCredentialing Committee Meetings

 

After all required information is collected and verified, provider credentialing and re-credentialing files are presented to the HNS Credentialing Committee for a final decision on the applicant’s participation with HNS. Credentialing meetings are held monthly during the last week of each month. 

 

Providers are not considered “participating" with HNS until they have received written notice from HNS, via the US Postal Service, informing them that their application has been approved and the effective date of their participation. Written notification of the decision made by the HNS Credentialing Committee is provided to each applicant whose credentialing file is presented to the Credentialing Committee.

  

 

  tracelogoRBProvider Rights and Responsibilities

 

Purpose:  To establish the rights and responsibilities of providers requesting participation or
                  re-appointment in the HNS Network.

 

Policy - Provider Responsibilities

 

       The provider applicant shall produce all information required by the application, or
       requested by HNS as permitted by law, in addition to the application, for proper
       evaluation
of his/her qualifications, including but not limited to licensure, malpractice
       insurance and
malpractice history, work history, competence, and character, and for
       resolving any doubts
about the provider's qualifications and professional integrity.

 

Policy - Provider Rights

 

The HNS Credentialing Program affords providers certain rights, including the right to be notified of the specific rights providers have.

HNS notifies applicants of their Rights and Responsibilities at the time of initial and re-application in a statement included in the letters that accompany the initial and re-credentialing application. 


Providers  have the  right:

  • To review information submitted to support their application.
  • To correct erroneous information.
  • To be informed, upon request, of the status of their credentialing application.
  • To be notified of these rights.

 

1.    To review information submitted to support their application.

Should a provider desire, he/she may request a review of the file.  Such reviews will include any information collected through the credentialing or re-credentialing process unless it is peer-review protected information or otherwise prohibited by law.  Reviews of credentialing files will only occur at the HNS premises and will take place at a mutually agreed upon time. The provider may not remove the file from HNS premises.  All reviews will be conducted in the presence of HNS credentialing staff.

 

2.    To correct erroneous information.

HNS will notify a provider by telephone or letter of any information obtained during the HNS credentialing or re-credentialing process that varies substantially from the information provided to HNS by the provider.  This includes, but is not limited to, substantial variation in information regarding licensure, malpractice claims history and reporting to government and/or authoritative agencies. Notifications will be sent to the provider within 5 business days from the date HNS becomes aware of the discrepancy.
 
The provider may submit additional or correct information to HNS, in writing.  HNS requires that all such information be signed by the provider; a staff member may not sign on behalf of the provider.  HNS may require that such documents be notarized.  Such information must be sent to the attention of the HNS Credentialing Director or Credentialing Specialist and must be received by HNS within 5 business days from the receipt of the original notice from HNS. The Committee will consider any additional information submitted by the provider.

 

3.    To be informed, upon request, of the status of their application.

HNS will promptly respond to a provider’s request for information regarding the status of their application.  Responses to such requests may be given either via telephone, facsimile, email or written notification sent via US Postal Service.  HNS will provide responses within 5 business days from receipt of the request.

When responding to such requests, HNS will provide the physician with: 

  • The date the application was received at HNS.
  • Actual status of the application on the date the inquiry was received.
  • The expected date by which the credentialing file shall be presented to the HNS Credentialing Committee.

       

4.    To be notified of the credentialing decision.

Providers have the right to receive written notification of HNS’ credentialing/re-credentialing decision within 10 business days from the date the decision was rendered.  

Appeal of Certain Credentialing Decisions:  

Providers also have the right to appeal certain credentialing decisions and to be notified of their right to appeal, and to be provided information about the appeals process, as applicable.

If the credentialing decision may be appealed, the notification received from HNS will clarify that right to appeal and will include information regarding the appeals process and the providers rights during the appeals process.