Provider FAQ

A clinically integrated network is a collection of health care providers who commit to work together on the quality and cost-effectiveness of care for a specific population. In simple terms, clinical integration is a continuous process that supports the triple aim of health care:

• Improving quality of care
• Reducing or controlling the cost of care
• Improving access to care and the overall patient experience

Through its Quality & Utilization Management, Credentialing, Cultural Competency, and other programs, HNS seeks to improve the quality, effectiveness, and efficiency of the health care delivery system in our service area, and to help control the costs of that health care. These efforts create efficiencies for contracted managed care plans, their members or beneficiaries, as well as for its contracted health care professionals.

HNS creates efficiencies in our service area by:

• Establishing mechanisms to monitor and control utilization of health care services provided by its contracted health care professionals designed to control costs and ensure quality of care, and
• Improving access to care in our service area, and
• Selectively choosing, for initial and continued participation, physicians who are committed to the consistent delivery of safe, quality, and cost-effective health care, and
• Developing and maintaining policies and standards which promote quality, cost-efficiency, and improve the overall patient experience, and
• Requiring the ongoing investment by health care professionals, both monetary and human, in its infrastructure, in order to achieve its efficiency objectives.

If you are interested in joining our network, please click the link to email the If you are interested in joining our network, please click the link to email the HNS Credentialing Department to request an application. If you are eligible for participation, we will mail you an application package right away.

All Providers: You must have your license number, your NPI number, and your Medicare PTAN (Medicare number) before submitting your application to HNS.

SC Providers: In addition to the above requirements, SC Providers must also have obtained their SC Medicaid number prior to submitting the credentialing application to HNS.

Our application package is not available online. However, we will promptly mail an application to you at your request.

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 HNS 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 four to eight weeks.

HNS 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.

The credentialing process may take four to eight 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.

You must have your license number, your EIN, your NPI number, and your PTAN (Medicare number) before submitting your application to HNS. SC providers must also have obtained their SC Medicaid number prior to submitting the credentialing application to HNS.

Once you receive written notification from the HNS Credentialing Committee that your application has been approved, you may begin seeing patients as an HNS “in-network” provider.

No, the effective date stated in your letter from HNS is the effective date of your participation in our network and is not retroactive.

You and your staff members should first thoroughly review the HNS / Payor Policies section of this website as well as the HNS Practice Protection Plan. Also, be sure to review all information included in the Billing/Claim Support section of this website.

Yes. Approximately five business days after you have received written notification that you are a HNS participating provider, you will receive a call from your personal HNS Service Representative. She will call you to introduce herself and to schedule the HNS Provider Orientation, which is required before you can begin submitting claims to HNS. During the orientation, she will review important information with you regarding your new status as an HNS participating provider.

Yes. There is a delay of about four weeks. Once a new provider has been credentialed with HNS, in addition to completing the HNS Provider Orientation, 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 takes approximately four weeks.
• Second, you must establish the manner in which you will submit your claims electronically to HNS. HNS only accepts electronic claim files submitted in the required HIPAA compliant 837p 5010 format. HNS offers two methods for submitting your electronic claim files. The preferred method is to submit the required 837p 5010 file to HNSConnect®, directly from your billing software. If, however, your billing software cannot produce an 837p 5010 file, you may submit your claim files to HNS via Office Ally™. Office Ally™ will convert your non-standard claim file to the required format and transmit your claims to HNS. HNS does not accept claim files from any other clearinghouse.

After you have established the manner in which you will submit your electronic claim files to HNS and after HNS has been notified that all contracted payors have updated their systems to reflect that you are now “in-network” with HNS, you may begin transmitting your claims to HNS. While this normally takes about four weeks, during this time, you ARE a participating provider with HNS and may treat patients as an “in-network” physician.

The insurance companies require several weeks to update their systems with information regarding newly credentialed providers. During this time you may find that certain insurance companies cannot yet verify your status as 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.

The HNS master tax ID 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.

Websites are usually updated within six to eight 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.

Yes. Newly credentialed physicians are provided with a copy of the HNS Practice Protection Plan, which is also included on 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 additional information to help ensure the delivery of safe, effective, cost-efficient health care.

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 websites to verify benefits. However, we caution all providers to remember that corporate medical policies supersede information given to you by payor phone representatives when verifying benefits. Prior to providing care, review both the HNS / Payor Policies and Payor Corporate Medical Policies and contact your HNS Service Representative if you have any questions.

The HNS Fee Schedules can be found on the secure portal of this website. If you have forgotten your unique username and password needed to access this secure portal, please contact your HNS Service Representative for assistance. Your HNS Service Representative’s email address is displayed on the provider dashboard on the secure portal of the HNS website.

No. The fees listed next to the CPT codes indicate the amount that you should receive, subject to co-payments, 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. Always verify benefits for each patient prior to providing services.

HNS issues bulk provider payments on the 10th, 20th (or next business day), and on the last business day of each month.

Please use the HNS Type 1 Change Form, the HNS Type 2 Change Form, or the HNS Additional Location Form from the HNS Documents section of this website 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
• Email Address
• Tax Identification / EIN (requires updated, completed W-9)
• Billing Company (if applicable)
• Practice Name (requires updated, completed W-9)
• Additions or deletions of providers in the practice
• Any actions taken by a state licensing board against your chiropractic license
• Any pending or settled malpractice claim

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.

Email your HNS Service Representative to request a credentialing application for your new physician. Please include the new provider’s full, legal name, license number, and the address to which the application is to be sent. We will promptly mail an application to your new provider. Please remember that all providers must have a Medicare PTAN number in order to be credentialed with HNS. Additionally, SC providers must also have a SC Medicaid number in order to be credentialed with HNS.

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 changes to your practice information. This includes providing us with information about your new practice. Please contact your HNS Service Representative for assistance with this. Your HNS Service Representative’s email address is displayed on the provider dashboard on the secure portal of the HNS website.

Use the HNS Additional Location Form from the HNS Documents section of this website to submit written notification of any changes. You will also need to complete and submit a new W-9 for any new location.

Please include:

• Physical and billing address of the new practice.
• The name of ALL providers practicing at the new location.
• The phone and fax numbers.
• The effective date that the new practice will open.

We will update our systems and notify our managed care partners of your additional location.

NOTE: Please remember that HNS credentials providers, not practices! Opening a second location does not guarantee participation in HNS for providers practicing at the second location who are not credentialed with HNS. Any additional providers will have to be credentialed through HNS first.

Please remember that each HNS provider must practice a minimum of 24 hours per week at his/her primary location to be a participating provider with HNS.

No. To prevent confusion for members seeking care from an “in-network” provider, ALL chiropractors practicing at the same physical location must participate with HNS or none of the chiropractors at that location may participate with HNS.

Both the NCQA and URAC require participating providers to be recredentialed every three years. HNS re-evaluates each provider’s credentials approximately every 30 months.

Yes. HNS will mail out your recredentialing application at least four weeks prior to the expiration of your current credentialing.

NOTE: 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 three years. Therefore, providers failing to recredential will be terminated from the HNS network and from all contracts with our managed care partners.

The term of the HNS Practitioner’s Participation Agreement (PPA) is one 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 advance notification to all 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 to members by HNS contracted payors.

Yes. There are three ways we notify our providers of important news and updates.

1. Email notifications.
2. Via US Mail.
3. The Current News section of this website.