Clinics in North Carolina and South Carolina may be required to submit claims for certain payors (such as Blue Cross Blue Shield of North Carolina, CIGNA Healthcare, MedCost, and others) through Health Network Solutions (HNS), a specialized clearinghouse. HNS does not accept claims from other clearinghouses, so you must upload your electronic 837 claim file directly to HNS.
This article will guide you through generating your electronic 837 claim files for payors that require submission via HNS.
Configure your Billing Profiles
Your billing profile contains your billing information that will be included in Box 33 of the CMS-1500, but it is also where you will indicate your clearinghouse settings.
For each billing NPI your clinic uses, you'll need one billing profile associated with your standard clearinghouse (like TriZetto or InfinEDI). You'll do this in Clinic Settings > Billing > Profiles.
Once complete, your billing profile for your standard clearinghouse will look similar to this:
Next, create another billing profile for each billing NPI your clinic uses, this time selecting Health Network Solutions (HNS) as the clearinghouse.
Some clinics include “HNS” in the profile name to easily distinguish it from their standard clearinghouse profile. If you prefer not to include “HNS” in the name (which appears on the claim), another common approach is to use all capital letters for one profile and standard casing for the other.
Once complete, your billing profile for HNS will look similar to this:
Set your payor-specific billing profile defaults
In ChiroUp, you can set payor-specific billing profile defaults for each provider. This ensures the correct billing profile is automatically applied to all claims based on the rendering provider and payor.
We’ll now walk through setting up payor-specific defaults for your HNS-specific payors.
Navigate to Clinic Settings > Users > Billing for each billing provider at your clinic.
Set the Default Billing Profile to the profile you use most often (usually your standard clearinghouse).
Set up default overrides for specific payors. For example, if all Blue Cross Blue Shield and Cigna claims must go through HNS, create an override to use your HNS billing profile for those payors.
See the image below for an example of how overrides appear.
Verify that claims have the correct billing profile
Once you set up your billing profile defaults, those defaults will apply to purchases created moving forward. We recommend verifying that your claims have the correct billing profile associated before sending out claims.
You can view a claim's associated billing profile in a few places:
On the purchase:
On the individual claim:
On the batch claim view:
Need to update billing profiles on existing claims?
To update the billing profile on one individual claim, use the Billing Profile drop-down on the related purchase.
To update the billing profile on a batch of claims, use the Update Billing Profile tool in Billing > Claims.
Once you've configured your billing profiles, you're ready to generate claims to be uploaded to HNS!
💡Pro Tip: You can only submit claim batches for one billing profile at a time. Use the Billing Profile filter when submitting claims to work with a single group at a time for smoother processing!
When you submit a claim or batch of claims using your HNS-specific billing profile, ChiroUp will automatically download the claim file to your computer.
Upload this file to your HNS Connect account!
Uploading ERAs
Once you've submitted claims to HNS and then receive back an ERA, you can manually upload the electronic 835 file directly to your ChiroUp account.
Under Billing > ERAs, click the green Upload button.
Use the pop-up window to upload your electronic 835 file!
This will automatically add the full ERA to your ChiroUp account, ready to be posted!
