HNS CONTRACTS

NC PROVIDERS

IF YOU ARE A NORTH CAROLINA PROVIDER, YOU SHOULD SEND CLAIMS FOR ALL COVERED SERVICES FOR THE FOLLOWING HNS CONTRACTS DIRECTLY TO HNS:

(This includes any self funded plans that utilize a HNS contracted payor as a third party administrator.)

CIGNA HEALTHCARE

MEDCOST

INCLUSIVE HEALTH

PRIMARY PHYSICIAN CARE

BCBSNC

BCBS Advantage

BCBS Options

BCBS Care

BCBS Choice

BCBS Select

NC State Employees Plan

Federal Employees Program (FEP)

All BCBS PPO Plans

All BCBS Out-of-State Plans

Blue Medicare Supplement plans - (will contain words BLUE MEDICARE SUPPLEMENT and will only include prefixes: YPZJ, YPZW)

All BCBS Out-of-State Medicare Plans

SC PROVIDERS

IF YOU ARE A SOUTH CAROLINA PROVIDER, YOU SHOULD SEND CLAIMS FOR THE FOLLOWING
HNS CONTRACTS TO HNS:

CIGNA HEALTHCARE

MEDCOST

PRIMARY PHYSICIAN CARE

ABSOLUTE TOTAL CARE

Healthy Connection Kids

SELECT HEALTH OF SOUTH CAROLINA

First Choice

First Choice Kids

VIRGINIA PROVIDERS

IF YOU ARE A VIRGINIA PROVIDER, YOU SHOULD SEND CLAIMS FOR THE FOLLOWING HNS CONTRACTS TO HNS:

MEDCOST

HNS Admin Fee

HNS wants you to understand why you pay an “admin fee” to HNS.   The HNS administrative fee is not a charge for “processing claims.”

HNS is an independent physician association (IPA).  We are a network of more than 1300 providers in North and South Carolina.  Our network of chiropractors contracts with insurance and managed care companies as their exclusive preferred provider organization (PPO) for chiropractic.  Patients who have insurance with the HNS contracted payors routinely choose to seek care from an “in-network” provider.  The names of the “in-network” providers are listed on the payor websites and in the PPO Provider Directories issued to employees. As a result of being in the network, the provider gains steerage of patients to his practice.

The admin fee provides the network with revenue to fund the cost of all of the dministrative functions that we provide. Some of these services include:

Network Development

Credentialing / Recredentialing

Contract negotiation

Utilization management

Central claims administration (central processing of your claims to the contracted       payors and disbursement of monies back to each provider)

Free electronic claims filing which continually provides more efficient and faster           claim filing HNS Provider Representatives to assist in answering claim filing questions,  and claim status.

Electronic Funds Transfer

Hippa ERA 835 file for automated payment posting

Free Continuing Education

Excellence in Action Program

Educational Website

Newsletters

HNS Practice Protection Plan

The HNS Admin Fee is calculated against the allowable amount on each member’s EOB. 

“The “allowable amount” is defined as the amount that the payor intends for the provider to collect for the service provided - that is represented by a particular CPT code.” 

The Allowable amount for each service is the sum of monies due from the patient and he insurance company and includes copayments and/or deductibles and/or coinsurance.

 Remember that all members’ insurance plans have either:

 a co-payment or

 a deductible and co-insurance

When the claim is adjudicated by the payor, the EOB and payment are sent to HNS most often in a large bulk payment and EOB file.  HNS then tracks and allocates all monies and EOB’s received from each insurance company, for each HNS provider, and sends the EOB and payment to each provider on the next scheduled HNS check cut date.

HNS does not take an admin fee when, per the EOB, the provider will not receive ANY payment for his services.  By calculating the admin fee against the “allowable” amount, this assures that HNS ONLY receives payment for services for which the provider will be paid  (whether the allowable amount is collected as a co-payment, deductible or from the insurance).

The HNS admin fee is calculated against the "allowable" or "contracted amount" shown on the Explanation of Benefits (EOBs) issued by the payors. 

Note:

HNS Utilizes Banker’s Rounding in calculating the HNS admin fee.

In calculating the HNS admin fee, HNS utilizes Banker's (or Statistician’s) Rounding.  In use by most banking and financial institutions, this type of rounding produces results that on average, round numbers down as often as they are rounded up. In any large set of numeric data, there is a fairly equal distribution of even and odd numbers and unlike conventional rounding, banker’s rounding prevents data from being skewed upward and also prevents the data from being skewed downward.   Banker’s rounding is considered the most unbiased form of rounding.

HNS’ software rounds based on the number in the 3rd decimal place.

In Banker’s Rounding

• If the third decimal is 0 - 4, the number is rounded DOWN. 

• If the third decimal is 6 - 9, the amount is rounded UP.

• If the 3rd decimal is 5, the amount is rounded to the nearest EVEN cent.

The HNS admin fee is applied to the “allowable” amount, and the allowable amount is calculated per service line on each EOB.  Remember, the

allowable is the sum of the amount paid by payor, and any co-payments, coinsurance/deductibles owed by the patient.  

The total admin fees shown on a particular HNS remittance summary are the sum of the admin fees for all service lines on the EOBs associated with that remittance summary.

Examples of Banker’s Rounding:

7.644 would round to 7.64

(The 3rd decimal is a 4 so number is rounded DOWN))

7.647 would round to 7.65

(The 3rd decimal is a 7 so number is rounded UP)

7.645 would round to 7.64

(The 3rd decimal is a 5 and the nearest EVEN cent would be 7.64, so number is rounded DOWN)

7.635 would also round to 7.64

(The 3rd decimal is a 5 and the nearest EVEN cent would be 7.64, so number is rounded UP)