HNS Policy  

General Policies

Name of Provider on Claim Form:  With the exception of claims for services provided by a locum tenens provider, all claims must include the name of the provider who rendered the service(s) shown on the claim.  

Filing Claims through HNS: Claims for all covered services provided to members whose health care plans contract with HNS must be filed through HNS.  This includes both primary and secondary claims (if the secondary payor contracts with HNS).  This also includes claims related to PI (personal injury).

Secondary Claims when Medicare is Primary:  Because secondary claims must be filed to HNS if the secondary payor contracts with HNS, and because secondary claims must be submitted to HNS with the primary EOB, if the primary payor is Medicare, all contracted HNS providers are required to file claims to Medicare on behalf of the patient, regardless of whether or not the provider accepts assignment from Medicare.  

Request Not to File Claims:  Providers should never initiate a conversation with a patient about not filing claims to HNS.  The only exception to a provider's contractual responsibility to file claims for covered services provided to HNS is if, and only if, the patient initiates a request not to file claims to his/her health care plan, and provided the policies below are followed.

Exception: Personal Injury Cases

In order to comply with a patient's request not to file claims when a third party payor is involved, prior to initiating treatment, provider's must have the patient sign the HNS Personal Injury Election Not to File Form.  (Because this form includes facts and information the member needs in order to make an informed decision, no other form is acceptable.)  The decision not to file is irrevocable, relative to covered services provided associated with the personal injury.  Once the treatment goals have been met (associated with the PI) and the patient is released from care, the Election Not to File is no longer valid. 

A copy of the signed form must be provided to the patient and the original must be maintained in the patient's health care record.

Exceptions: All Other Requests

Other than PI cases, if a patient requests the provider not file claims to their health care plan, the provider may ONLY comply with such requests if the patient first signs the HNS Election Not to File Form.  (Because this form includes facts and information the member needs in order to make an informed decision no other form is acceptable.)  A copy of the signed form must be provided to the patient and the original must be maintained in the patient's health care record.  The decision not to file is irrevocable but only with respect to covered services provided until the treatment goals outlined in the treatment plan (for the presenting condition) have been reached.  Once the treatment goals have been reached the Election Not to File is no longer valid.  (For services provided prior to 05/01/17, the health care record must have included a dated and signed statement by the member which clearly indicated the patient's request not to file claims to the health care plan.)

If the patient initiates the request not to file and the appropriate HNS Election Not to File form is obtained, the provider cannot discount any fees for services provided to the patient. The provider must charge his/her usual and customary fees for all services provided.

Participating providers who fail to comply with these policies may lose their status as an HNS Participating Provider.

Important Note: Prior to providing care, providers are required to determine if the member has insurance coverage through a health care plan that contracts with HNS.  Failure of a patient to inform the provider that they have health insurance does not relieve the provider of this responsibility; the provider must ask the patient if they have health insurance.

Except as otherwise noted here, participating providers who fail to submit claims to HNS may lose their status as a Network Provider.

Timely Filing Policy

All primary claims must be filed to HNS within 15 days of date of service.  All secondary claims must be filed within 15 days of receipt of primary EOB.  Please review the HNS Policy "Timely Filing" (under HNS/Payor Policies) for specific HNS and contracted payor policies.

Electronic Claims Filing Policy

HNS will accept electronic claim files via the following methods:

1. HNSConnect®
    

   HNS accepts HIPAA compliant ANSI 5010 837p claim files submitted to HNSConnect® directly from the physician's practice management software.  HNS cannot accept 837p claim files submitted in version 4010.
   
   

   For assistance with submitting your 5010 837p files to HNSConnect® via direct submission from your practice management software, please contact your HNS Service Representative or click the link to email This email address is being protected from spambots. You need JavaScript enabled to view it..

    

    

2. Office Ally™
    

   If your software system cannot produce the required HIPAA compliant 837p 5010 claim files, you may submit your claims to HNS through Office Ally™.  HNS cannot accept claim files from any other clearinghouse.  For more information about enrolling with Office Ally™, please review the Office Ally™ section of this website.

    

    

3. Manual Entry via HNSConnect®
    

   You may file primary claims to HNS by manually entering claim data into HNSConnect®.