tracelogoRB HNS Administrative Fee

 

 

 

 

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.

 

The HNS admin fee is used to pay the costs for all of the programs, services, and administrative functions provided and is the network's only source of revenue.  (HNS does not receive any compensation from the insurance companies and managed care organizations that contract with HNS.)

 

CINs

A clinically integrated network is a collection of health care providers who commit to work together on the quality and cost-effectiveness of care for a specific population.  In simple terms, clinical integration is a continuous process that supports the triple aim of health care:

  • Improving quality of care

  • Reducing or controlling the cost of care

  • Improving access to care and the overall patient experience  

 

Through its Quality & Utilization Management, Credentialing, Cultural Competency, and other programs, HNS seeks to improve the quality, effectiveness, and efficiency of the health care delivery system in our service area, and to help control the costs of that health care.  These efforts create efficiencies for contracted managed care plans, their members or beneficiaries, as well as for its contracted health care professionals.

 

HNS creates efficiencies in our service area by:

  1. Establishing mechanisms to monitor and control utilization of health care services provided by its contracted health care professionals designed to control costs and ensure quality of care, and

  2. Improving access to care in our service area, and

  3. Selectively choosing, for initial and continued participation, physicians who are committed to the consistent delivery of safe, quality, and cost-effective health care, and

  4. Developing and maintaining policies and standards which promote quality, cost-efficiency, and improve the overall patient experience, and

  5. Requiring the ongoing investment by health care professionals, both monetary and human, in its infrastructure, in order to achieve its efficiency objectives.

Services provided include, but are not limited to:

  • Network Development/Management

  • Credentialing

  • Contract Negotiation

  • Quality and Utilization Management

  • Clinical Resources

  • Peer-to-Peer Support

  • Cultural Competency Program

  • Post-Payment Audit Assistance

  • Chiropractic Advocacy

  • Complaints/Grievance Resolution

  • Continuing Education (both online and live seminars)

  • Educational Website

  • Central Claims Administration

  • Electronic Claims Filing (to improve efficiency and faster payments)

  • Electric Funds Transfer (EFT)

  • Automated Payment Posting (HNS provides remittance data via HIPAA ERA 835 files.)

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