Participating Provider Request

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Provider Information

Date of Request

Last Name or Facility

First Name

Mailing Address

Address

City

State

Zip Code

Title

Group Name

Contact Information

Name

Tax ID

Email

Phone

Fax

Requested Items/Services

Client List

Provider / Facility Manual

Request your Contracted Rates / Fee Schedule / Enter CPT Codes below:

Status of Credentialing Application

Request a Service Visit

Other, please explain:

CHN PPO is a leading preferred provider organization offering a fully credentialed national network. The cornerstone of our network is our top-quality health care providers who specialize in diagnosing and treating automobile and workplace injuries.

Additional Services

Pre-Certification
Utilization Management
Medical Bill Auditing
Bill Negotiations
Telephonic & Field Case Management

Who We Serve

Workers Compensation PPO
Group Health Plans
Auto Insurers
Self-Insured Employers
TPAs

CONTACT US

The Medlogix Family of Companies includes Integrity, CHN PPO, MEG (IMEs), and ReviewWorks
providing a full range of medical claims management services for auto liability, workers compensation, group health, and IME Services.

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