tracelogoRB Reference Guide for Pruitthealth Premier

 

Important Note:  Effective December 18, 2020, HNS will no longer contract with Pruitthealth Premier. HNS Network Physicians will have 90-days from the effective termination date - until March 18, 2021 - to submit Pruitthealth Premier claims to HNS for dates of service prior to December 18, 2020. For dates of service on or after December 18, 2020, please file claims directly to Pruitthealth Premier at the address provided on the back of the patient's ID card.

 

The Pruitthealth Premier Quick Reference Guide provides information specific to the Pruitthealth Premier plan concerning Pruitthealth Premier claims, Pruitthealth Premier members, and Pruitthealth Premier policies. The information in this section is in addition to the HNS/Payor Policies. The Pruitthealth Premier Quick Reference Guide contains the following information specific to Pruitthealth Premier and provides you with helpful information regarding your Pruitthealth Premier claims.

 

General Information

 

Eligibility/Benefits

 

Prior Authorization

 

Subscriber ID Cards

 

Claims Submission

 

Claims Inquiries

 

Provider Relations

 


 

General Information

 

Pruitthealth Premier is a Medicare Advantage Institutional Special Needs Plan (SNP) designed to improve the care for residents of NC and SC. Pruitthealth Premier's target population is an institutionalized Medicare beneficiary who resides or is expected to reside in a Pruitthealth Premier contracted long-term care (LTC) facility for 90 days or longer. Pruitthealth Premier was designed to provide personalized, compassionate clinical care and services for Pruitthealth Premier Members.

 

Please do not send claims directly to Pruitthealth Premier.  All Pruitthealth Premier claims must be sent to HNS. Please ignore the claims billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits. You are under contract as a participating Pruitthealth Premier provider through HNS, and our instructions for filing claims supersede information given to you by Pruitthealth Premier Representatives.

 

If you have any questions about Pruitthealth Premier, please contact your HNS Service Representative at (877) 426-2411 before calling Pruitthealth Premier.

 

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Eligibility/Benefits

 

Be sure to ALWAYS verify eligibility for each Pruitthealth Premier member.

 

You can verify member eligibility the following ways: 

  • Provider Web Portal:The PruittHealth Premier web portal allows providers to verify eligibility online 24/7 at https://pruitthealthpremier.com/
  • By phone:  Please call the Member Services Department at 1-844-224-3659.

 

Please remember to ask for specific information on chiropractic benefits for each member. CLICK HERE to see a sample Verification of Eligibility/Benefit Form.  

  

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Prior Authorization

 

Prior authorization is required for services provided to Pruitthealth Premier members.

 

The prior authorization number must be included on the claim form.

 

The provider is responsible for requesting prior authorization of all scheduled services/procedures. Pruitthealth Premier recommends calling at least five (5) days in advance of the procedure or service. Requests for prior authorization are prioritized according to level of medical necessity. For prior authorizations, providers should call:  (844) 224-3659, OPTION 3.

 

You may also submit your request via the online portal 24 hours per day, 7 days per week at:  https://pruitthealthpremier.com/.

 

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Pruitthealth Premier ID Cards

 

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Claims Submission

 

Please do not send claims directly to Pruitthealth Premier.  All Pruitthealth Premier claims must be sent to HNS.  (Please ignore the billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits.)

 

At this time, ALL Pruitthealth Premier claims must be submitted to HNS by paper via the CMS 1500 claim form.  This includes primary claims as well as secondary, corrected, and claims with attachments.

 

  • Claims must be identified as Pruitthealth Premier claims in the address section at the top of the CMS 1500 claim form (HNS/Pruitthealth is an acceptable format).

Example:
HNS/Pruitthealth

PO Box 2368
Cornelius, NC 28031 

  • Enter the word Pruitt in box 11 (group number) on the claim form.
  • Pruitthealth must be included in box 11c.
  • The prior authorization number must be included in box 23. 

 

If you have any questions about Pruitthealth Premier, please contact your HNS Service Representative at (877) 426-2411 before calling Pruitthealth Premier.

  

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Claims Inquiries

 

For assistance from HNS on claims status, (after 60 days from your billing date), please email your HNS Service Representative, and provide the patient name, date of birth, member ID number and the dates of services in question. We will gladly trace the claim for you and will respond back to you within 3 business days.

  

Resubmit lost/missing claims through HNS.

 

Refer to your HNS/Pruitthealth Premier fee schedule to confirm allowable amounts. All HNS fee schedules are located on the secure section of this website.

 

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Provider Relations 

 

Questions relating to your participation in Pruitthealth Premier should be directed to your HNS Service Representative at (877) 426-2411.

  

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