HNS Policy
HNS providers shall ensure the delivery of cost-efficient care, as defined by HNS Comparative Practice Program parameters, to members of healthcare plans that contract with HNS.
Introduction
The HNS Code Audit Program helps achieve the two Clinical Integration (CI) objectives of improving quality of care and helping to control the cost of care.
Consistent with our responsibility to promote quality and cost-efficient healthcare and educate providers, on a semiannual basis, HNS conducts reviews of Network Physicians’ individual utilization of certain services (i.e., CPT/HCPCS codes) that may:
- Indicate quality of care issues;
- Indicate sub-optimal utilization; and
- Subject the physician to close scrutiny of the physician’s practice patterns by contracted healthcare plans.
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for a summary of the
HNS Comparative Practice Patterns
Review & Code Audit Programs