Verifying Eligibility & Benefits

 

 HNS Policy  

HNS providers are required to verify eligibility and benefits prior to rendering services by contacting the member’s health care plan.  Written documentation indicating you have verified eligibility and benefits and the information obtained during this phone call must be included in the patient’s health care record.

 

Always Use the HNS EIN and NPI

Contracted payors have network providers listed under the HNS EIN and HNS' NPI. When verifying benefits, always provide these numbers:

 

HNS EIN: 56-1971088

 

HNS NPI: 1093773392

  

Corporate Medical Policies

When verifying benefits, please remember that payor corporate medical policies do not apply to self-funded employer groups. Self-funded employers determine what services will, and will not be, covered.

 

When verifying benefits, always clarify that you are verifying chiropractic benefits and always obtain a reference number from the payor.

 

Providers should verify and/or document: 

  • The name of the payor representative who provided the information regarding eligibility and benefits, as well as the reference number.

     

  • The date the information was obtained.

     

  • If the patient’s coverage includes chiropractic care.

     

  • If the patient’s coverage is in effect for the planned course of treatment.

     

  • The amount of the patient’s deductible, co-payment and/or co-insurance.

     

  • The maximum number of chiropractic visits allowed in a calendar or benefit year.

     

  • Any annual maximum chiropractic plan benefit.

     

  • If the services to be rendered are covered benefits under the health care plan.

     

  • If the services are covered benefits when rendered by a chiropractor.

     

  • If the plan covers maintenance/supportive care.

     

  • If the patient has pre-existing conditions.

     

All services that are routinely performed in your office should specifically be addressed when verifying benefits to determine if the planned services are covered services under the member’s plan.

 

Verification of benefits should also be done at the beginning of each member’s plan year as well as any time the patient obtains new insurance coverage and/or anytime you want to provide a new and/or different service. 

 

Please remember that information obtained from payor phone representatives does not supersede applicable corporate medical policy or published plan benefits.