tracelogoRB HNS Administrative Fee

 

 

 

 

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 is a clinically integrated network (CIN) whose mission is to make health care more accessible, more effective and more affordable. One of the requirements for a CIN is the ongoing investment (both monetary and human) in the network's infrastructure by the network participants to enable the network to meet its efficiency objectives.

 

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

  • In-office Translation Services

  • Clinical Resources and Support

  • Central Claims Administration (central processing of your claims to the contracted payors and disbursement of monies back to each provider)

  • Board-approved Continuing Education

  • Electronic claims filing to improve efficiency and faster payments

  • Administrative Support Services, including HNS Service Representatives, to assist in resolving claims/payment issues

  • Electronic Funds Transfer

  • HIPAA ERA 835 file for automated payment posting

  • Educational Website

 

 Calculation of the Admin Fee:

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 co-payment/co-insurance amount, plus the amount paid by the health plan, for each service line on the EOB.

 

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 EOBs 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 co-payment, deductible, co-insurance or from the insurance plan).