GROUP HEALTH PPO

CHN PPO Group Health offers employer groups affordable top-quality health care providers across all specialties

CHN PPO’s network of over 228,000 fully credentialed healthcare providers offers high-quality, cost-effective care to employer groups.

We specialize in mitigating rising healthcare costs with fixed-rate provider contracts, ensuring our clients don’t have constraints of a more expensive, proprietary PPO network. 

Clients also benefit from our add-on pre-certification, utilization management and case management services.

Our medical claims solutions combine quality care with medical expense controls. 

  • CHN PPO seamlessly integrates high levels of credentialing, accessibility, and cost savings across the board.
  • We work closely with the provider, patient, and family to assure patients receive the appropriate treatment in the right setting. 
  • Our staff includes experienced, full time, on-site medical directors, specialty physician advisors, experienced nurse case managers, and utilization review pre-certification nurses.
Shot of a group of young doctors having a discussion in a modern office.

CHN PPO can be accessed as a full-service PPO network, including physicians, hospitals, and ancillary providers, OR it can be utilized as a Physician/Provider only network

Doctor working on computer and calculator to calculate data

CHN PPO services are integrated with MyMedlogix, our proprietary, web-based case management and bill review software.

This integration allows us to provide bill review and PPO network decisions that are linked seamlessly, enhancing staff efficiency and productivity for our clients. 

MyMedlogix features a customizable, user-friendly platform and real-time access to the ongoing management of claims.

Group Health Services

Our flexibility, responsiveness and quality management practices, coupled with customizable services and flexible network configurations, has made CHN PPO the preferred choice for regional and national carriers.

Medlogix case managers conduct pre-certifications in accordance with each customer’s plan to assess medical necessity and duration of care while ensuring consistency with clinical protocols. Services may include prior authorization, utilization review, and case management to determine whether the treatment plan is medically necessary and provides the appropriate level of care consistent with clinical protocols. Treatment that does not meet this criterion is escalated to a medical director. Medlogix® manages the entire pre-certification process, including appeals and dispute resolution.

We offer both retrospective and concurrent utilization management services designed to provide high-quality, well-managed care while reducing unnecessary claims costs. This highly-experienced team, which includes Medical Directors, Specialty Physician Advisors, Nurse Case Managers and Utilization Review nurses, works closely with providers to confirm that treatment plans meet the level of care for optimum outcomes.

Medlogix has a dedicated team of registered nurses who perform extensive reviews of facility and provider bills to ensure all services billed were appropriately documented and causally related to the claim. Depending on the need, audits can be performed at a desktop level or on-site at the provider facility.

Our team of health care professionals use their years of training and medical expertise to review records to verify all billed services are properly supported in the documentation provided. Documentation is also reviewed to confirm that all treatment rendered was as a result of the accident and not a pre-existing medical condition that would not be the responsibility of the insurer. The audit process also includes the application of all state regulatory requirements and the application of any appropriate fee schedule.

Audit results are compiled and presented in a detailed narrative report and include a worksheet that outlines eligible/ineligible charges.

Bill negotiations reduce the costs of medical bills from providers and facilities not participating with a provider network for total cost management. The negotiation team proceeds with a review of UCR,
Medicare, claims utilization history and in-network payment rates to aggressively negotiate with non-network hospitals, physicians, and ancillary health care providers to reduce costs.

Medlogix’s Bill Negotiation program includes:

  • Direct negotiations by experienced, highly-skilled negotiators with expertise and knowledge of rate levels
  • All negotiations are confirmed with signed Letters of Agreement from providers
  • High acceptance rate – average of 70%
  • Prospective and retrospective negotiations
  • Customized referral criteria

The direct oversight of a medical professional provides valuable guidance for complex or catastrophic cases, or those that are not progressing as expected. Nationally certified registered nurses (CCM and/or CRRN) with three to five years of catastrophic case management experience assess and coordinate treatment by working with medical care providers, employers, attorneys, injured persons and their families to ensure quality health services are delivered cost-effectively. The result is decreased hardship to individuals and their families as a result of their injuries and reduced financial exposure for insurers and employers.

Case management is directed toward:

  • Early identification and assessment
  • Discharge planning
  • Planning for complications
  • Identifying appropriate physician, facilities and outpatient referrals, avoiding unnecessary hospital admissions, and negotiating appropriate rates and levels of care
Join Our PPO Network

FREQUENTLY ASKED QUESTIONS

Yes, healthcare providers can join CHN PPO’s network and gain access to a large base of insurance carriers, TPAs, and public entities, with support for onboarding and fee negotiation.

Group Health PPO | CHN PPO

CHN PPO Group Health offers employer groups an affordable healthcare solution through a network of over 230,000 providers, featuring real-time claims management. Key features include cost mitigation with fixed-rate contracts, a comprehensive provider network, add-on services like pre-certification and case management, and a customizable platform with integrated MyMedlogix software. The service emphasizes a patient-centered approach with experienced medical staff, ensuring quality care and medical expense control. Group health services encompass pre-certification, utilization management, large case management, medical bill auditing, bill negotiations, and field case management.

More information:

What is PPO Billing?

CHN PPO Group Health offers real-time claims management. Key features include cost mitigation with fixed-rate contracts, a comprehensive provider network, and a customizable platform. The service focuses on medical expense control.

What is PPO?

A Preferred Provider Organization (PPO) is a type of health insurance plan that allows members to seek medical care from doctors, hospitals, and other healthcare providers within a specific network. Unlike Health Maintenance Organizations (HMOs), PPOs typically do not require members to choose a primary care physician (PCP) or obtain referrals to see specialists. This flexibility allows members to access a wider range of healthcare services without the need for prior authorization, although seeing in-network providers usually results in lower out-of-pocket costs.

What is a group health ppo

A Group Health PPO (Preferred Provider Organization) is a type of health insurance plan that an employer or organization offers to a group of people, typically their employees and their dependents. It's one of the most common types of group health plans due to its flexibility.

Here's a breakdown of what that means:

  • Group Health: This refers to health insurance coverage provided to a collective, like a company's employees, rather than individuals purchasing their own separate policies. Group plans often come with lower premiums and shared costs due to the larger risk pool.
  • PPO (Preferred Provider Organization): This is the specific structure of the health plan, offering:
    • Network of Preferred Providers: The insurance company has contracts with a network of doctors, hospitals, specialists, and other healthcare facilities (known as "in-network" providers) who agree to provide services at negotiated, discounted rates.
    • Flexibility to Choose: PPO plans offer more flexibility than some other plan types (like HMOs). While you pay less out-of-pocket when you use "in-network" providers, you still have the option to see "out-of-network" providers. However, using out-of-network providers will typically result in higher costs (e.g., higher deductibles, coinsurance, or a lower percentage of the bill covered by the plan).
    • No Referrals Needed: A significant advantage of PPO plans is that you generally do not need a referral from a primary care physician (PCP) to see a specialist. You can go directly to any specialist within or outside the network.
    • No Required PCP: You are typically not required to choose or stick with a single primary care physician.

In essence, a Group Health PPO provides employees with a balance of cost savings (when staying in-network) and freedom of choice (with the option to go out-of-network for a higher cost), without needing referrals for specialists. This makes them a popular choice for many employers looking to offer comprehensive benefits.

 

Similar Keywords:

  • Preferred Provider Organization
  • Health Insurance Plan
  • Healthcare Network
  • Medical Providers
  • Insurance Coverage
  • Managed Care
  • Network Providers
  • Out-of-Network
  • In-Network
  • Medical Benefits

Not the page you are looking for? Here are our other pages

 

Medical Record Review Services

Auto Liability PPO (PIP)

Bill Review Services 

CHN PPO Connecticut

Group Health PPO

CHN PPO New Jersey

PPO Claims Management

PPO Provider Network

Workers Compensation PPO

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