tracelogoRB Reference Guide for PruittHealth

 

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

 

General Information

 

Eligibility/Benefits

 

Prior Authorization

 

Subscriber ID Cards

 

Claims Submission

 

Claims Inquiries

 

Provider Relations

 


 

General Information

 

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

 

Please do not send claims directly to PruittHealth.  All PruittHealth 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 provider through HNS, and our instructions for filing claims supersede information given to you by PruittHealth Representatives.

 

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

 

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Eligibility/Benefits

 

Be sure to ALWAYS verify eligibility for each PruittHealth 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 www.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 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 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:  www.pruitthealthpremier.com.

 

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PruittHealth ID Cards

 

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Claims Submission

 

Please do not send claims directly to PruittHealth.  All PruittHealth 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 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 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, please contact your HNS Service Representative at (877) 426-2411 before calling PruittHealth.

  

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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 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 should be directed to your HNS Service Representative at (877) 426-2411.

  

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