HNS Contract requirements

Requirements

to Adhere to HNS Policies and Procedures

(HNS Practitioner’s Participation Agreement)

Policies and Procedures.  HNS may prepare, or cause to be prepared or adopted from time to time, such written policies, procedures, forms, instructions, and other materials, as it may deem appropriate in order to develop, coordinate and implement its services.  Such policies and procedures may be amended by HNS from time to time as provided in Section 9.3 hereof.  HNS shall provide an updated copy of its current policies and procedures to Participant at least annually by posting the same on HNS’ website.

Administration.  Participant agrees to cooperate with, abide by and participate in all administrative policies and procedures that may be established by HNS or a Payor including, but not limited to, those set forth in any policy manual.  Participant further agrees to abide by the terms of any and all contractual agreements that exist or may be entered into between HNS and Payors.

Implementation of Case Review and Quality Assurance Programs.  HNS may arrange for the formulation and implementation of case review and quality assurance programs.  Where a Payor has established its own programs, HNS and Participant shall participate in and cooperate with those programs.  The parties agree that all activities of this nature conducted by HNS and Participant shall be conducted, to the extent practicable, in such a manner as to be subject to, and obtain the privileges and immunities of applicable laws pertaining to peer review activities by organizations such as HNS.  If HNS implements a case review program, HNS shall make a reasonable attempt to inform and seek additional information from Participant when a claim is under further review with respect to the medical necessity of the services provided by Participant.  If HNS as a part of its claim review process has to make a determination or recommendation not to approve payment for services by Participant, it shall promptly notify Participant of this decision.  As part of a case review program, HNS shall maintain a grievance procedure for review of case review determinations affecting Participant.  A copy of the grievance procedure shall be available to Participant upon request.

Compliance with Quality Assurance, Utilization Review Credentialing and Other Programs and Policies.  Participant agrees to comply fully with, and participate in the implementation of, Payors’ policies and programs as described in the applicable Payor Options and any applicable provider manuals.  Participant further agrees to participate in and abide by such HNS Quality Assurance, Claims Payment Protocols, and Utilization Review Program(s) (“QA/UR Program(s)”) as may be adopted or implemented from time to time by HNS.  HNS shall provide Participant with specific QA/UR Programs as adopted or implemented, upon request.  Failure to comply with this provision may be considered grounds for immediate termination of participation with HNS.  Credentialing and quality assurance review shall occur periodically at the discretion of HNS.  Participant shall comply with HNS’ credential verification program and any provider sanctions program.