Health Network Solutions, Inc. : Select Health guide

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QUICK REFERENCE GUIDE

PRE-AUTHORIZATION FORM

SAMPLE CMS 1500

select health of south carolina quick reference guide for chiropractic

Select Health of South Carolina Quick Reference Guide For Chiropractic

The Select Health of South Carolina Quick Reference Guide provides information specific to the Select Health plan and First Choice concerning Select Health claims, Select Health members, and Select Health policies. The information in this section is in addition to the HNS/Payor Policies, HNS Documentation, and HNS Billing Guidelines.

General Information

Eligibility/Benefits

Referral System

Select Health ID Cards

Claims Submission

Claims Inquiries

Provider Relations

General Information

PLEASE REMEMBER: Do not send claims directly to Select Health! If you are a newly credentialed provider, you may not be able to obtain the required pre-authorization for the first 30 days from your effective date. Select Health's provider system will not be able to identify you as an "in-network" provider during that time and has asked that you wait the first 30 days before rendering services to Select Health members.

Please ignore the claims billing address on the member ID card or any address given to you on the telephone when verifying eligibility and benefits. You are under contract as a participating Select Health of South Carolina provider through HNS and our instructions for filing claims supersede information given to you by Select Health!

Select Health of South Carolina has contracted with HNS as their chiropractic network for the State's Medicaid program, First Choice.

First Choice is a Medicaid health plan. First Choice members keep their regular Medicaid, but receive extras like free personal healthcare items, health education and nurse advice and support.

With few exceptions, all claims for COVERED SERVICES provided to a beneficiary of a HNS contracted payor MUST be submitted to HNS.

If you have any questions about a Select Health/First Choice claim, please contact your HNS Provider Rep at (877) 426-2411.

Eligibility/benefits

Please remember to ask for specific information on chiropractic benefits for each member. CLICK HERE to see a sample Verification of Insurance Form.

To verify eligibility and benefits - Refer to the telephone number on the member’s identification card or call (888) 276-2020.

Prior authorization is required for Select Health plans. To obtain prior authorization, please call (888) 559-1010. CLICK HERE to use the Select Health Pre-Authorization Form.

Please note: Obtaining a prior authorization number is no guarantee of patient eligibility and benefits. You must first call to verify eligibility and benefits before obtaining a prior authorization number.

Select Health has attached the HNS EIN to all HNS providers, so you MUST use the HNS TAX ID number

(56-1971088) in order to receive in-network verification. (If you use your own EIN when verifying eligibility and benefits, you will be told you are not listed as a participating provider.)

Referral System

No referral from a PCP is required, but Select Health prefers that patients be referred by the patient's PCP.

If a patient was referred to you by the PCP, you must use boxes 17 and 17b on the claim form to identify the referring physician.

Select Health ID Cards

First Choice is the only Select Health plan that should be filed through HNS at this time.

If you are uncertain about where to file a claim, please use your HNS Fax Inquiry Form and fax a clear, legible copy of the member ID card to HNS and we will respond back to you with an answer within 24 hours.

Claims Submission

All claims for First Choice must be submitted to HNS through the HNSConnect system. Exceptions include corrected claims or any claims with attachments.

CLICK HERE for information on filing Corrected Claims.

Ignore any instructions regarding where to submit claims by payor phone representatives. HNS instructions regarding where to submit claims supersede all other instructions given by payor representatives when verifying benefits.

In order for Select Health claims to adjudicate quickly and accurately, please note the following information regarding claims submission specific to Select Health in addition to the HNS Billing Guidelines.

First Choice should be in box 11 (this is the group number).

Select Health or First Choice must be in box 11c.

The prior authorization number must be in box 23.

If you receive a referral from the PCP, box 17 must be completed.

If you receive a referral from the PCP, box 17b must be completed.

Even when filing the claim electronically, the claim must be identified as a Select Health claim in the address section at the top of the CMS 1500 claim form (HNS/Select Health is an acceptable format) using the example below:

Example:   HNS/Select Health

                    PO Box 2368
                    Cornelius, NC 28031

Claims Inquiries

For tracing outstanding claims (after 60 days from your billing date), complete the HNS Fax Inquiry Form and fax to HNS. Please include the patient name, date of birth, member ID number, and each date of service you would like traced. We will gladly trace the claim for you and will respond back to you within 3 business days.

Resubmit lost/missing claims through HNS.

Refer to your HNS/Select Health Fee Schedule to confirm allowable amounts if prior authorization was obtained before rendering services.

Provider Relations

Questions relating to your participation in Select Health should be directed to your HNS Provider Rep

at (877) 426-2411.