HNS Policy 

Who Can File Claims to HNS:

Providers

Only providers who have been credentialed with HNS and are active HNS providers can provide and bill for care on behalf of a member who has insurance with a health care plan that contracts with HNS.

EXCEPTION: If services were provided by a locum tenens ("fill-in") provider working for the HNS in-network provider and all locum tenens requirements have been met, services provided by the "fill-in" provider may be submitted under the name of the HNS in-network provider who contracted with the "fill-in" provider.  For more information, please refer to the policy on Locum Tenens Providers for requirements regarding locum tenens billing.

New Associate / Employee Chiropractors

If you have a new associate in your practice that is not yet credentialed with HNS, the associate provider cannot provide care to any patient whose health care plan contracts with HNS until the provider is appropriately credentialed with HNS.

NOTE: You cannot submit claims in your own name for services provided by a provider who is not credentialed with HNS.

If you have hired a new associate, please contact HNS immediately so we can assist with credentialing this provider. Until the provider is credentialed by HNS, he/she must not provide any physician services to a patient whose insurance processes through HNS.

Patients

Network providers are required to file claims on behalf of those patients who have health insurance with a health care plan that contracts with HNS.  Claims submitted by the patient to HNS or directly to the health care plans will not be processed.

Name/NPI Number (Rendering Provider)

All claims submitted to HNS must include the name and the Type I NPI number of the provider that actually rendered the services reported on the claim form. Your signature on the health care claim form is an attestation that you provided the services.

The Type 1 NPI number of the rendering provider must be included on each service line in box 24J on CMS 1500 claim form. If you have a Type II NPI number, place your Type II NPI number in boxes 32a and 33a of the CMS 1500 claim form.

EXCEPTION: If services were provided by a locum tenens (“fill-in”) provider and all locum tenens requirements have been met, services provided by the “fill-in” provider may be submitted under the name/NPI number of the provider who contracted with the “fill-in” provider. For more information, please refer to the policy on Locum Tenens Providers for requirements regarding locum tenens billing.

If you are in a group practice or share call coverage with other providers, take special care to assure the accuracy of the rendering provider’s name on each claim submitted.

If you discover that a claim (or claims) was submitted incorrectly with the wrong rendering provider’s name, you must promptly file corrected claims to correct the error.  Your prompt recognition of this and your immediate correction can reduce payor concerns of suspected fraud and abuse.

Verifying Eligibility and Benefits

HNS providers must always verify eligibility and benefits prior to rendering care.

HNS providers must always ask if a patient has health care coverage.

If the patient has health care coverage, the provider must obtain a copy of the member’s ID card. Copies of the member’s current ID card must be maintained in the health care record.

If a patient denies having health care coverage, the patient (or legal guardian if the patient is a minor) should be required to sign an attestation statement clarifying this. The attestation statement should be maintained in the patient’s health care record.

Covered Services

Claims for all covered services provided to members whose health  care plans contract with HNS must be filed to HNS. (This includes both primary and secondary payors as well as any self-funded groups who utilize an HNS contracted payor as a third party administrator.)

EXCEPTION: If a patient requests not to file claims to their health care plan, providers must comply with this request, but may ONLY do so if the patient (or legal guardian) has signed one of the two HNS Election Not to File Forms, and the form is included in the health care record. (Because these forms included facts and information needed to make an informed decision, no other forms may be used as evidence the member does not want their health care claims submitted to their health care plan.)

Non-Covered Services

In general, claims for non-covered services should not be filed through HNS.

EXCEPTION: Coordination of benefits with secondary payors and/or if needed for reimbursement for HSA/HRA accounts.

Timely Filing

HNS providers must file all primary claims within 15 days of the date of service OR if secondary claims, within 15 days of the date the primary EOB was received.

HNS providers must comply with payor timely filing requirements. Payor timely filing requirements are posted under 'Timely Filing' under HNS/Payor Policies.

(Please remember that timely filing limits will vary among payors. Limits on timely filing should be obtained when verifying benefits for each patient.)

• NC Providers:  Based on North Carolina laws, BCBSNC and CIGNA reserve the right to deny claims that are submitted more than 180 days from date of service. 

NOTE: For out-of-state BCBS claims, because you are in-network through BCBSNC, the timely filing policy for BCBSNC supersedes the home plan’s timely filing. 

• SC Providers:  Based on South Carolina laws, CIGNA reserves the right to deny claims that are submitted more than 90 days from date of service.

 
Making sure claims are filed in a timely manner will facilitate prompt payment of the claim(s) and will reduce denials due to timely filing limits.

Primary Claims

With few exceptions, all primary claims must be submitted electronically to HNS via HNSConnect^®.  

Secondary Claims

HNS providers are required to file all secondary claims through HNS if the secondary coverage is provided by a HNS contracted payor.  At this time, secondary claims must be sent to HNS via the CMS 1500 claim form.  

Please remember when filing secondary claims, the EOB from the primary payor must be attached to the secondary claim. Payors cannot adjudicate secondary claims without the primary EOB.

Corrected Claims and Claims with Attachments

A corrected claim is a claim that has already been adjudicated and needs to be filed for correct processing. In other words, to file a “corrected claim” you must already have received an EOB/NOP from the payor.

Corrected claims and/or claims with attachments, such as office notes, must be filed through HNS.  Such claims must be submitted on a CMS 1500 paper claim form and mailed or faxed to HNS.

Box 22 of the CMS form must be completed with the number 7 for all corrected claims, and under "Original Ref. No." you must include the word "corrected".

When submitting a corrected claim, you may only submit one date of service, per claim.

All health care providers are charged with reporting accurate information on insurance claim forms.  Information submitted on claim forms to HNS contracted payors that is inaccurate or erroneous must be corrected as soon as the provider becomes aware of the error.

HNS providers must promptly correct the inaccurate information by filing a corrected claim to correct the information previously submitted and per the instructions noted above.

Refunds

HNS providers must not send refunds directly to the contracted payor for services billed and paid through HNS.

In the event of a refund request, the rendering provider who was paid for the services is solely responsible for the repayment of funds paid in error, and or requested via a bona fide refund request from a contracted payor. If the provider is an employee in a group practice, HNS will recoup the funds from the employer provider under whose EIN the payment was to be reported. 

Duplicate Payments/Overpayments/Underpayments

All health care providers are charged with reporting accurate information on insurance claim forms.  Information submitted on claim forms to HNS contracted payors that is inaccurate or erroneous must be promptly corrected.

An overpayment is an improper or excessive payment made to a health care provider as a result of patient billing claims, and/or claims processing errors for which a refund is owed by the provider. Posting the EOB within 30 days will assure your prompt recognition of these issues and your immediate correction can reduce payor concerns of suspected fraud and abuse. 

If you receive a duplicate payment, a payment in excess of the contracted allowable, payment for services that should not have been billed or payment for services not provided, etc., HNS providers must comply with the following requirements:

• If the payment/overpayment is less than $250.00, you must immediately file a corrected claim to the payor.
  

   

• If the payment/overpayment is $250.00 (or greater) than the amount you were due, you must promptly contact HNS.

   

• If you have received monies in excess of $250.00 of the amount due, HNS reserves the right to:

1. Require you to submit a certified check or money order, payable to HNS, for the full amount of the overpayment . If repayment or refund is required by HNS, it must be submitted to HNS within 10 days of the date requested by HNS.

    

   OR

    

2. Recoup, or allow the payor to recoup, the total amount of the overpayment from future HNS checks until the amount due has been repaid. Additionally, HNS reserves the right to recoup, up to the total amount due, all funds from any providers in a group practice who are receiving payment under the same EIN as the EIN of the provider who owes the payment to HNS.

If a claim (or claims) was adjudicated incorrectly by the payor, and the EOB/NOP reflects less than the contracted allowable, please contact your HNS representative and she will assist you in resolving the issue(s).

Posting EOBs

HNS providers must post all HNS EOBs within 30 days of the date the EOBs are uploaded to the HNS website.  Posting your EOBs within 30 days will assure your prompt recognition of incorrect or inappropriate payments, allow for immediate correction of these issues, and will reduce the likelihood of payor concerns of suspected fraud and abuse.