HNS Policy  

HNS providers shall ensure the delivery of cost-efficient care, as defined by HNS Comparative Practice Program parameters, to members of healthcare plans that contract with HNS.

 


 

Introduction

The HNS Code Audit Program helps achieve the two Clinical Integration (CI) objectives of improving quality of care and helping to control the cost of care.

 

Consistent with our responsibility to promote quality and cost-efficient healthcare and educate providers, on a semiannual basis, HNS conducts reviews of Network Physicians' individual utilization of certain services (i.e., CPT/HCPCS codes) that may:

  • Indicate quality of care issues;

  • Indicate sub-optimal utilization; and

  • Subject the physician to close scrutiny of the physician's practice patterns by contracted healthcare plans.

  

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for a summary of the

HNS Comparative Practice Patterns

Review & Code Audit Programs