tracelogoRBFrequently Asked Questions - Credentialing 

        1. How do I become a HNS provider?

           

        2. May I download the application online?

           

        3. Once I submit an application to HNS, will I be a participating provider with HNS?

        4. What is the credentialing process?

        5. How long does the credentialing process take?

           

        6. When can I begin to see patients as a HNS participating provider?

           

        7. Can you make my effective participation date retroactive?

           

        8. What is the first thing I should do after I am notified that I am a HNS provider?

           

        9. Once I receive written confirmation that I am in the network, will HNS contact me to help me get started?

           

        10. Is there a waiting period for a new provider’s claims to be processed?

           

        11. I have just been notified that I am now a HNS provider but when I call the insurance companies, I am told that I am not listed in their system as a participating provider. Why does this occur?

           

        12. How long will it take my name to appear in the directories and on the websites of the insurance companies?

           

        13. Can I have a non-par provider practicing in my office?

 

 

1.    How do I become a HNS provider?

 

If you are interested in joining our network, please call the HNS office at (888) 712-6488, to request an application. If you are eligible for participation, we will mail you an application package right away.

You must obtain your Medicare PTAN number before submitting an application to HNS and if you are a SC Provider, you must also obtain your SC Medicaid number prior to submitting an application to HNS.

 

 

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2.    May I download the application online? 

 

Our application package is not available online. However, we will promptly mail an application to you at your request.

 

 

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3.    Once I submit an application to HNS, will I be a participating provider with HNS?

 

No, you will not be a participating provider until the credentialing process has been completed and you have received written notification of the decision by the HNS Credentialing Committee. If accepted, this letter will inform you of the effective date of your participation in our network. From that date forward, you will be considered an in-network provider. The credentialing process takes about 4 to 8 weeks.

 

 

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4.    What is the credentialing process? 

 

HNS adheres to both URAC and NCQA guidelines for credentialing. Our providers are subject to credentialing criteria that examine education, certification, licensure, practice history, criminal history, and malpractice history. HNS participating providers must be re-credentialed at least every three years.

 

 

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5.    How long does the credentialing process take?

 

The credentialing process may take 4 to 8 weeks from the time we receive your completed application at HNS. We are often able to complete the process in less time. The HNS Credentialing Committee meets the last week of each month. In general, if HNS receives a completed application by the last business day of the month, the file may be presented to the Credentialing Committee by the end of the following month.

 

 

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6.    When can I begin to see patients as a HNS participating provider?

 

Once you receive written notification from the HNS Credentialing Committee that your application has been approved, you may begin seeing patients as a HNS “in-network” provider.

 

 

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7.    Can you make my effective participation date retroactive?

 

No, the effective date stated in your letter from HNS is the effective date of your participation in our network and is not retroactive.

 

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8.    What is the first thing I should do after I am notified that I am a HNS provider?

 

Before you are considered an "active" HNS provider, you must successfully completed several HNS training modules. All of the training is available on the HNS website, and must be completed within 20 days of the effective date or your participation in the HNS Network. Your HNS Service Representative will review these, and other requirements during your initial orientation call.  Additionally, you and your staff members must thoroughly review the HNS / Payor Policies section of this website as well as the HNS Practice Protection Plan  prior to providing any chiropractic services to members with insurance contracts through HNS. 

 

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9.    Once I receive written confirmation that I am in the network, will HNS contact me to help me get
       started?

 

Yes. Approximately 5 business days after you have received written notification that you are a HNS participating provider, you will receive a call from your personal HNS Service Representative. She will call you to introduce herself and to schedule the HNS Provider Orientation. Completion of the orientation call by the physician is required before you are considered "active" with HNS.  During the orientation, your Service Representative will review important information with you regarding your new status as a HNS participating provider.

 

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10.  Is there a waiting period for a new provider’s claims to be processed?

 

Yes.  Once a new provider has been credentialed with HNS, there are two processes that must be completed prior to submitting claims.

 

    • First, HNS must forward your credentialing information to our managed care partners so this information can be loaded into their systems. This process usually takes approximately 4 weeks.

 

    • Second, you must establish the manner in which you are going to submit your primary claims electronically to HNS.  HNS only accepts electronic claim files submitted in the required HIPAA compliant 837p 5010 format.  HNS offers 2 methods for submitting your electronic claim files. The preferred method is to submit the required 837p 5010 file to HNSConnect, directly from your billing software.  If, however, your billing software cannot produce an 837p 5010 file, you may submit your claim files to HNS via Office Ally. Office Ally will convert your non-standard claim file to the required format and transmit your claim to HNS.  HNS does not accept claim files from any other clearinghouse.

 

After you have established the manner in which you will submit your electronic claim files to HNS and after HNS has been notified that all contracted payors have updated their systems to reflect that you are now "in-network" with HNS, you may begin transmitting your claims to HNS.  This normally takes about 4 weeks but HNS will notify you as soon as you may begin submitting your claims to HNS. 

 

 

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11.  I have just been notified that I am now a HNS provider but when I call the insurance companies, I am
       told 
that I am not listed in their system as a participating provider.  Why does this occur?

 

The insurance companies require several weeks to update their systems with information regarding newly credentialed providers. During this time you may find that certain insurance companies cannot verify you are a participating provider. This may occur until their systems have been updated with your information.  

 

You are a participating provider as of the effective date stated in the letter you received from HNS.  All claims submitted after your effective date will be processed as “in-network” claims once the insurance companies have updated their systems.

 

Additionally, our managed care partners have HNS participating providers listed under the HNS master tax number (EIN) or NPI number. When calling to verify benefits or check the status of a claim, you will need to use the HNS EIN or NPI number rather than your individual EIN or NPI. Please contact your HNS Service Representative and she will assist you with this information.

 

 

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12.  How long will it take my name to appear in the directories and on the websites of the insurance

       companies?

 

Web sites are usually updated within 6 to 8 weeks of the credentialing date. Directories are updated at various times during the year; your name and practice information will be listed in the next published directory. Consider sending a letter to your patients and local employers now, informing them of your “Participating Provider” status with each of the insurance plans on your list of HNS Contracts.

 

 

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13.  Can I have a non-par chiropractic provider practicing in my office?


No.  To prevent confusion for members seeking care from an "in-network" physician, ALL chiropractic physicians practicing at the same physical location must participate with HNS or none of the chiropractors may participate.
 

 

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