Manuals
HCS publishes this manual for network providers, hospitals and their administrative staff to help with daily interactions with HCS and its clients. Information in this manual is current and replaces all other manuals previously published by HCS.
Network physicians, other healthcare professionals, hospitals, and ancillary providers are required to follow the policies and procedures contained in this manual. Failure to comply with any policies and procedures may constitute a breach of the Agreement.
Statement of Nondiscrimination
Practitioners and facilities must not differentiate or discriminate in the treatment of patients on the basis of race, color, gender, national origin, age, disability, pregnancy, gender identity, sex, sexual orientation or health status in the administration of the plan, including enrollment and benefit determinations. Practitioners must have policies to prevent discrimination in health care delivery and implement procedures to monitor and ensure it does not occur.
Appeals
HCS seeks to resolve appeals in a timely manner. An appeal is a written request for the reconsideration of a medical bill payment or medical treatment decision rendered by HCS.
Arbitration
Arbitration is a written request for dispute resolution.
Billing & Reimbursement
Physicians, other health care professionals, ancillaries and hospitals should submit bills promptly after services are rendered.
Claimant ID Cards
Claimant ID Cards may be issued to workers’ compensation or PIP claimants after HCS or its clients are notified of a work- related illness or injury or an automobile accident. In some cases, ID cards may be issued prior to final coverage determinations. In other cases, ID cards may not be issued.
Fraud Detection and Control
HCS physicians and other health care professionals play an important role in helping to control fraud and abuse.
Information Privacy & Confidentiality
HCS is not considered a covered entity under the Health Insurance Portability and Accountability Act (HIPAA). However, we value our customers’ privacy and take steps to ensure that the health information we receive is protected and kept confidential.
Participating Physicians and Other Health Care Professionals
The policies and procedures contained in this section of the website provide information concerning your responsibilities as a participating physician or other health care professional.
Utilization Management
Our Utilization Management (UM) Program is designed to achieve medically appropriate and cost-effective delivery of health care services to claimants within the parameters of the covered benefits.
This manual does not modify the terms of any Agreement with HCS. In the event of any conflict between the Agreement and the information contained in this manual, the terms of the Agreement shall prevail.