Service
HN1's staff works cooperatively with participating providers, participating payors to foster the team approach that will enable all participants to achieve their goals.

Technology
HN1 enhances the services to our customers by utilizing today's latest technology and expanding the capabilities of our proprietary system, Global Data System (GDS). GDS has been extensively refined for our robust business requirements to ensure that our clients gain the utmost flexibility in adjudicating and paying claims, and that our providers receive correct, timely payment.

Quality
HN1 is committed to maintaining a quality network for its clients, and their covered members, and has structured its provider participation guidelines accordingly. Medical providers and practitioners are approved for participation in HN1's provider panel based on industry standards and guidelines. 

Obtaining quality and value is the ultimate challenge for healthcare benefit managers. HN1 provides value for the benefit dollar by offering consistency and cost savings to help overall expenditures.

Capitated Network Management Services

The primary source for revenue for HN1 is through Capitated Network Management Services. Under these payor agreements, HN1 is paid a capitation fee for the professional or both the professional and technical components of one or more medical specialty(ies). As part of these agreements, HN1 may use its existing network of contracted providers, the health plan’s existing provider network, or some combination of its provider network and the health plan’s provider network. HN1 also would usually assume responsibility for some or all of these operational functions:

• Claims Payment

• Referrals/Authorizations

• Provider Contracting, Provider Relations and Network Development

• Payor Relations

Fee-For-Service Network Management Services

Under these arrangements, HN1 is paid an administrative fee for operating one or more provider specialty networks on behalf of a health plan. HN1 also provides management oversight and performs the some or all of the following operational functions:

• Provider Contracting and Provider Relations

• Referrals/Authorizations

• Network Development

• Credentialing

• Payor Relations

Under these arrangements, a bonus or bonus/penalty provision could be instituted based on whether or not any Part B (professional) and/or Part A (facility) savings are achieved by a health plan through HN1’s management of their specialty network(s).

HN1 would typically provide these management services to health plans that 1) have high medical expenses for a certain specialty but do not want to have claims payments performed/delegated to an outside party and/or 2) when a health plan wishes to retain its existing provider network but seeks assistance from HN1 in order to help reduce its current medical expense level for a particular medical specialty.

Provider Network Access & Development

Under these arrangements, HN1 is paid an administrative or an access fee for developing a network of providers or leasing its existing provider network to a health plan. Under these arrangements, HN1 could also be paid a bonus for any Part B and/or Part A Savings achieved or incur a financial penalty should Part B and/or Part A expenses increase or remain unchanged while under the management of HN1.

Under a network services arrangement, Payers often delegate some or all of the following administrative functions to HN1:

• Network Development

• Provider Relations

• Utilization Management

• Referrals / Authorizations

• Claims Payment

• Credentialing (optional)

HN1 would typically provide these management services to health plans that have recently entered a new market service area and do not have an existing provider network and/or do not have the internal resources to expand its existing provider network.