 providers frequently asked questions
View answers by clicking on questions listed below.
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What happens if I wish to terminate my provider agreement with HNS?
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1. How do I become a HNS provider?
If you are interested in joining our network, please call the HNS office at (877) 426-2411 ext 2 to request an application. We will be happy to mail you an application package right away.
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2. May I download the application online?
Our application package is not available online. However, we will promptly mail an application to you at your request.
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3. Once I submit an application to HNS, will I be a participating provider with HNS?
No, you will not be a participating provider until the credentialing process has been completed and you have received written notification of the decision by the Credentialing Committee. If accepted, this letter will inform you of the effective date of your participation in our network. From that date forward, you will be considered an in-network provider. The credentialing process takes about 4 to 6 weeks.
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4. What is the credentialing process?
HNS strictly adheres to both URAC and NCQA guidelines for credentialing. Our providers are subject to credentialing criteria that examine education, certification, licensure, practice history, criminal history, and malpractice history. HNS participating providers must be recredentialed at least every three years.
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5. How long does the credentialing process take?
The credentialing process may take 4 to 6 weeks from the time we receive your completed application at HNS. We are often able to complete the process in less time. The HNS Credentialing Committee meets the last week of each month. In general, if HNS receives a completed application by the last business day of the month, the file may be presented to the Credentialing Committee by the end of the following month.
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6. When can I begin to see patients as a HNS participating provider?
Once you receive written notification from the HNS Credentialing Committee that your application has been approved, you may begin seeing patients as a HNS “in-network” provider.
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7. Can you make my effective participation date retroactive?
No, the effective date stated in your letter from HNS is the effective date of your participation in our network and is not retroactive.
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8. What is the first thing I should do after I am notified that I am a HNS provider?
You and your staff members should first thoroughly review the HNS/HNS payor policy section of this website as well as teh HNS Practice Protection Plan. Also, it will be very helpful if you and your CA review the HNS billing guidelines and the important information regarding claims filing through HNS. This should be done prior to providing any chiropractic services to members with insurance contracts through HNS.
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9. Once I receive written confirmation that I am in the network, will HNS contact me to help me get started?
Yes, approximately 5 business days after you have received written notification that you are a HNS participating provider, you will receive a call from your personal HNS Provider Representative. She will call you to introduce herself and to go over important information with you regarding your new status as a HNS participating provider.
After you have spoken with your HNS Provider Rep, your billing staff will be contacted by a HNSConnect® Representative to assist your office in registration and testing for submitting your claims electronically to HNS.
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10. Is there a waiting period for a new provider’s claims to be processed?
Once a new provider has been credentialed with HNS, there are two processes that must be completed prior to submitting claims.
First, HNS must forward your credentialing information to our managed care partners so this information can be loaded into their systems. This process usually takes approximately 2 weeks.
Second, HNS requires that all primary claims are filed electronically to HNS, so we must register you to send your claims to HNS via HNSConnect®, our electronic claims processing system. A HNSConnect® Representative will contact you shortly after you have been credentialed to get started with your HNSConnect®testing. Testing may take 2 to 3 weeks, and once completed, a HNSConnect® Rep will contact you to start submitting your claims.
When the managed care partners have confirmed that you have been loaded into their systems, and your HNSConnect® testing has been completed and you are ready to send your claims electronically to HNS, you will be notified by a HNS Representative that you may start submitting claims. While there is a slight delay in the filing of your claims immediately after being accepted as a HNS Provider, please remember that during this time, you are an “in-network” participating provider with HNS.
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11. I have just been notified that I am now a HNS provider but when I call the insurance companies, I am told that I am not listed in their system as a participating provider. Why does this occur?
It takes insurance companies approximately 2 weeks to get their systems updated with information on newly credentialed providers. During which time, you may find that certain insurance companies cannot verify you are a participating provider. This may occur until their systems have been updated with your information. You are a participating provider as of the effective date stated in the letter you received from HNS. All claims submitted after your effective date will be processed as “in-network” claims, once the insurance companies have updated their systems.
Additionally, our managed care partners have HNS participating providers listed under the HNS master tax number (EIN) or NPI number. When calling to verify benefits or check the status of a claim, you will need to use the HNS EIN or NPI number rather than your individual EIN or NPI. Please contact your HNS Provider Rep and she will assist you with this information.
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12. What is the HNS master tax number (EIN)?
The HNS master tax number (EIN) is 56-1971088. Our managed care partners have HNS participating providers listed under this master EIN. When calling to verify benefits or check the status of a claim, you will need to use this EIN, rather than your individual EIN.
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13. How long will it take my name to appear in the directories and on the web sites of the insurance companies?
Web sites are usually updated within 6 to 8 weeks of the credentialing date. Directories are updated at various times during the year; your name and practice information will be listed in the next published directory. Consider sending a letter to your patients and local employers now, informing them of your “Participating Provider” status with each of the insurance plans on your list of HNS Contracts.
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14. Does HNS have an Instruction manual or other guidebook?
Yes. Please print the HNS Practice Protection Plan from this website. This manual includes important payor and HNS policies that must be followed by all network providers, and includes important information about claims filing, contract information, and much more.
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15. Do I call HNS to verify patient eligibility and benefits?
No, HNS cannot verify eligibility or benefits because we do not have access to the information about your patient’s insurance plan. You should call the member’s insurance company or utilize their web sites to verify benefits. However, we caution all providers to remember that corporate medical policies supersedes information given to you by payor phone representatives when verifying benefits. We urge you to first check the Payor Corporate Medical Policies, (found in the Practice Protection Plan) or contact your HNS Provider Rep to determine if services are consistent with payor corporate medical policies, prior to providing care. (Please note: members of the Federal Employee Plan are NOT subject to the BCBSNC CMP. Providers should contact the FEP plan to verify what services are covered chiropractic benefits.)
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16. How do I know what fees are paid by each insurance plan?
The HNS Fee Schedules can be found on the secure section of this web site. If you have forgotten your unique username and password needed to access this secure section, please contact your HNS Provider Rep for assistance.
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17. If the CPT code is listed on the HNS Fee Schedule, does this mean it is a covered service for all of my HNS patients?
No. The fees listed next to the CPT codes indicate the amount that you should receive, subject to coppayments, coinsurance and deductibles, provided the service is a covered chiropractic benefit under the member’s health plan and the member is eligible for benefits on the date the service was provided.
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18. How often do we receive payments from HNS?
HNS issues bulk provider payments on the 10th, 20th and 30th (or closest business day) of each month.
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19. Does HNS have a newsletter?
Yes. Our quarterly newsletter, the HNS Connector is sent via email to all network providers and is also posted on our web site under the "WHAT'S NEW" section.
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20. How do I notify HNS of any changes in my practice information?
Please use your HNS Provider Change Form to notify HNS of any changes and attach additional pages as needed. Please indicate the effective date of each change. Your contract with HNS requires that you notify HNS immediately if there is ANY change of practice information such as:
Address
Addition of Satellite Office
Phone/Fax Number
Tax Identification (requires updated, completed W-9 form)
Billing Company (if applicable)
Practice Name (requires updated, completed W-9 form)
Additions or deletions of providers in the practice
Any change to the status of your chiropractic license
Any pending or settled malpractice claim
Any Medicare or Medicaid sanction
DO NOT SEND NOTIFICATION OF ANY CHANGES DIRECTLY TO THE INSURANCE COMPANIES! HNS WILL NOTIFY OUR MANAGED CARE PARTNERS OF ANY CHANGES SUBMITTED TO HNS.
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21. I am adding another provider to my practice. How do they become credentialed with HNS?
Call your HNS Provider Rep or use the HNS Fax Form to request a credentialing application for your new physician. (Please include the new provider’s full, legal name, and the address to mail the application.) We will promptly mail an application to your new provider.
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22. I am leaving my current group practice and starting my own practice (and/or joining another group practice). Will I need to re-apply with HNS after I leave my current group practice?
HNS credentials providers, not practices. If you leave one group practice to join another, or open your own practice, you will not need to re-apply with HNS. However, per your HNS contract, you must immediately notify HNS of any changes to your practice information. This includes leaving your group practice and providing us with information about your new practice. Please contact your HNS Provider Rep and she can assist you with this.
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23. I want to open another practice in a different location. How do I inform HNS?
Use the HNS Provider Change Form and submit written notification of any changes. You will also need to complete and submit a new W9 Form for any new location. Please include the physical and billing address of the new practice, the name of the providers practicing at the new location, name of the new practice, phone and fax numbers, and the effective date that the new practice will open. We will update our systems and notify our managed care partners of your additional location. Please remember that HNS credentials providers, not practices, and opening a second location does not guarantee participation in HNS for providers practicing at the second location who are not credentialed with HNS. So, any additional providers will have to be credentialed through HNS first. Also, please remember that each HNS provider must practice a minimum of 28 hours at his/her primary location to be a participating provider with HNS.
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24. Can I have a non-network provider in my practice?
If you and another provider are practicing in a group practice, under a single EIN, or with a group NPI number, then all providers practicing within the group must be HNS participating providers, or none of the providers in the group can be HNS participating providers.
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25. How often do I have to be recredentialed?
Both the NCQA and URAC require participating providers to be recredentialed every 3 years and HNS often recredentials every two years.
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26. Will you notify me when I am due to be recredentialed?
Yes. HNS will mail out your recredentialing application at least 4 weeks prior to the expiration of your current credentialing. (Always notify HNS of any changes in your practice information so that we have accurate information in our system when it is time to recredential you.) Our managed care partners have delegated the credentialing and recredentialing process for all participating providers to HNS. NCQA and URAC, the organizations that dictate credentialing policy to our managed care partners, require all providers to be recredentialed every 3 years. Therefore, providers failing to recredential will be terminated from the HNS network and from all contracts with our managed care partners.
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27. What happens if I wish to terminate my provider agreement with HNS?
The term of the HNS Practitioner’s Participation Agreement (PPA) is one (1) year beginning on the date of execution of the Agreement and shall automatically renew on an annual basis unless (a) either party gives thirty (30) days written notice prior to the end of the annual term of its intention not to continue the Agreement, or (b) the Agreement is otherwise terminated per the terms of the HNS Practitioner's Participation Agreement.
Notification 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 but such notices may be sent directly by HNS contracted payors.
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28. Does HNS notify us when there is a change involving one of the HNS contracts?
Yes! HNS will promptly notify you of any changes regarding any of our managed care partners. There are four ways we notify our providers of important news and updates.
Important news and updates are promptly added to the What’s New section of this web site.
HNS sends important information via e-notices to our network providers.
Information will be sent to you via U.S. Mail and/or may be included in your HNS provider check packet. (Always be sure to review all information in each HNS check packet.)
Our quarterly newsletter contains important news as well as helpful tips on claims submission. Current and past issues are available for download on this web site.
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