credentialing / recredentialing information

HNS is responsible for the credentialing and re-credentialing of all network providers.  Our credentialing program meets both NCQA and URAC’s strict requirements as well as state and federal statutes. The HNS Credentialing Plan and policies are posted on this website under the HNS/HNS Payor Policies. HNS is an open panel network and providers who are interested in becoming participating providers with HNS should contact HNS and request an application. 

Credentialing is the initial process through which HNS collects, reviews, and verifies specific criteria and pre-requisites in order to determine a provider’s eligibility for participation with HNS. The credentialing process for a new provider takes 6 to 8 weeks, once the application is received by HNS.  The application is then reviewed and the process of verification of information begins.  Incomplete applications are returned to the provider with a letter outlining what is needed for the application to be considered complete.  For each applicant, HNS will obtain additional information from the appropriate malpractice carrier, the appropriate state licensing board, The National Practitioner Data Bank (NPDB) and The Chiropractic Information Network Board Action Databank (CINBAD) and/or other sources as may be required.

Credentialing Committee Meetings

After all required information is collected and verified, provider credentialing and re-credentialing files are presented to the HNS Credentialing Committee for a final decision on the applicant’s participation with HNS.  Credentialing meetings are held monthly during the last week of each month.  Providers are not considered “participating with HNS” until they have received written notice from HNS, via the US Postal Service, informing them that their application has been approved and the effective date of participation.  Written notification of the decision by the credentialing committee is provided to each applicant who submits an application to HNS.

Addition of an Associate to your practice

Thinking of adding a new associate to your individual or group practice?  As soon as you are sure that you will be adding a new provider, please contact your HNS Provider Rep so that we can assist you with getting the new provider credentialed as soon as possible.   The new chiropractor submit claims through HNS for any services until he/she has been credentialed and accepted into the network. 

PROVIDERS MUST BE ALL IN-NETWORK or ALL OUT-OF-NETWORK

All providers in a group who practice at the same location under the same EIN number must be participating providers with HNS, OR none of the providers can participate in the network. To clarify, one provider in your group cannot be in-network while another provider at your office is out-of-network with HNS. 

Credentialing Instructions
Following these instructions carefully will assist in expediting the credentialing process.

Before submitting your application packet, please make sure that your packet contains:

1. The completed Checklist attached to your application
2. Signed and dated Attestation statement
3. A completed W-9 form
4. Hold Harmless Agreement (for NC & SC Providers only)
5. Completed application with current date and signature
6. Copy of provider’s state license registration clearly showing expiration date
• For NC providers, this is the large 8 1/2” x 11” license renewal showing the expiration date of your license
  
• For SC providers, this is the small, wallet-size registration showing the expiration date of your license
• For VA providers, this is the 8 1/2" x 4" license renewal showing the expiration date of your license
7. Explanation to all “Yes” responses on the “Professional Information” questionnaire
8. Copy of the fact sheet from your current professional liability insurance policy indicating:
• Name of provider
  
• Minimum coverage amount of  $1,000,000/$3,000,000
  
• Effective date and expiration date (Policy coverage dates)
  
• Policy number
9. Complete work history, beginning with date you graduated from Chiropractic College.  All gaps of 90 days or more must be explained in writing on a separate sheet. In completing the work history on page 8, you must begin with the date of your Chiropractic College graduation (on page 7). On page 8, list all work since the date you graduated from Chiropractic College through today’s date.
10. Two signed & dated Provider Agreements
11. Two signed & dated Business Associate Addendums
12. Two Completed Provider Evaluation Forms (Letters of Recommendation)
13. Completed HNSConnect® Registration Form
14. Signed HNSConnect® Provider Agreement (EDI Agreement)

The checklist attached to your application must be completed and returned with the application.

Please do not leave any sections blank. Please write N/A if not applicable.

If you have any questions about how to complete your credentialing application, please contact Ms. Sandy Cooke, Director of Credentialing, at (919) 341-8033 or email her at scooke@healthnetworksolutions.net.

Please call HNS to review the application by phone BEFORE mailing to HNS.   This will significantly expedite the credentialing process!

Provider Rights:

The following rights are for each provider applying for credentialing and/or recredentialing with HNS:

Recredentialing

Re-credentialing is the process through which HNS collects, reviews, and verifies specific criteria and pre-requisites in order to determine a provider’s continued eligibility for participation with HNS.

Re-credentialing is required at least every three years.  A re-credentialing application will be sent to each participating provider at least thirty days prior to the expiration of the provider’s last credentialing date.  The provider must complete and return the re-credentialing application and all documents by the requested date, in order for continued network participation with HNS.  Failure to recredential by the required due date can result in termination of the HNS provider contract.

In order to assist you with this process, we have completed parts of the recredentialing application for you. 
When you receive your recredentialing application, it is very important that you carefully review each section to assure the accuracy of the information before submitting to HNS.  If any of the pre-filled information is incorrect, please provide correct, current information.

If you have any questions about how to complete your recredentialing application, please contact Ms. Sandy Cooke, Director of Credentialing, at (919) 341-8033 or email her at scooke@healthnetworksolutions.net. The checklist attached to your application must be completed and returned with the application.

Prior to submitting your application packet, please make sure that your packet contains:

If you have any questions while completing the recredentialing application, please call us at (919) 341-8033.  We will be happy to assist you.

Provider Rights:

The following rights are for each provider applying for credentialing and/or recredentialing with HNS:

Renewal Of and Termination of HNS Provider Agreements.

The term of the HNS Practitioner’s Participation Agreement (PPA) shall be one (1) year commencing on the date of execution of the Agreement and shall automatically renew on an annual basis unless either party gives at least thirty (30) days written notice prior to the end of the annual term of its intention not to continue the Agreement, or as otherwise provided per the terms of the HNS PPA.

Notification of Termination to HNS contracted payors.  

Within 15 days of the effective date of any provider termination from HNS, HNS provides notification to all HNS contracted payors of such terminations, together with the effective date of termination.  HNS does not provide notice of terminations to payor beneficiaries, however such notices may be sent to beneficiaries directly from HNS contracted payors.