CHN PPO serves as your medical claims management, managed care, and PPO partner, guiding each Workers Compensation case from First Report of Injury to optimal MMI and RTW outcomes.
We offer employers an integrated proactive approach to effectively managing work-related injuries and help control escalating medical and indemnity costs for Workers Compensation.
As with our Auto Liability services, our Workers’ Compensation services are powered by our proprietary, web-based case management and bill review MyMedlogix software, featuring a customizable, user-friendly platform and real-time access to the ongoing management of a claim. MyMedlogix streamlines claims management and avoids third-party delays.
From the time of injury through the end of the treatment path, the Medlogix case manager ensures the injured worker receives timely and medically necessary treatment 24/7 and 365 days per year.
- Progress is tracked on nurse medical case management, case status, provider billing, and RTW status. Automatic alerts are issued for a change in work status, compensability, and more.
- Users receive individual secure logins so adjusters and case managers have access to all file activity in real-time.
Nationwide access via vetted affiliate PPO partners.
- CHN PPO providers are credentialed and monitored specifically for PIP and Workers’ Compensation expertise.
- Strong direct provider relationships improve speed, outcomes, and documentation for Workers’ Comp claims.
- The CHN PPO Network includes specialists in workplace injury treatment across multiple facility types (hospitals, rehab centers, chiropractors, etc.).
- Tailored state-by-state network configurations based on utilization and analytics.
CHN PPO handles Workers’ Compensation claims from first report to final payment—not outsourced.
- First Report of Injury (Intake & State Reporting)
- Assistance in locating appropriate providers for the care needed
- Bill review
- EDI Connectivity
- PPO rate application
- Telephonic and Field Case management
Out-of-network Workers’ Comp claims meeting negotiation criteria are routed to bill negotiators for savings with result in signed Letters of Acceptance (LOAs).
Workers' Compensation Services
FREQUENTLY ASKED QUESTIONS
Workers Compensation PPO | CHN PPO
CHN PPO Group Health offers employer groups an affordable healthcare solution through a network of over 228,000 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 the meaning of PPO network?
A PPO network (Preferred Provider Organization network) is a group of healthcare providers (doctors, hospitals, clinics, specialists, etc.) who have agreed to provide services to members of a PPO insurance plan at negotiated, discounted rates.
What is the most common workers' comp claim?
A: The most common workers' compensation claims often involve sprains, strains, and tears, particularly to the back, neck, and shoulders. These types of injuries frequently result from:
- Overexertion: Lifting, pushing, pulling, holding, carrying, or throwing objects.
- Falls, Slips, and Trips: Injuries sustained from falling on the same level or from a height.
- Repetitive Motion Injuries: Such as carpal tunnel syndrome, which develop over time from repeated movements.
- Contact with Objects/Equipment: Being struck by or caught in machinery or falling objects.
While the exact leading cause can vary slightly by industry and year, musculoskeletal injuries from overexertion and falls consistently rank among the top workers' compensation claims.
What is Workers' Compensation PPO?
A: A Workers' Compensation PPO (Preferred Provider Organization) is a specific type of managed care network designed to deliver medical services for work-related injuries and illnesses. It's built on the same principles as a standard health insurance PPO but tailored for workers' compensation claims.
Here's what it entails:
- Network of Approved Providers: The PPO consists of a curated group of doctors, specialists, hospitals, and therapists who have agreed to provide treatment for work injuries at negotiated rates. These providers are often chosen for their expertise in occupational medicine and their understanding of workers' compensation regulations.
- Cost Containment: By directing injured workers to in-network providers, the system aims to control medical costs associated with workers' comp claims through pre-negotiated fees.
- Managed Care Principles: It incorporates elements of managed care, which can include:
- Treatment Protocols: Ensuring that care aligns with established guidelines for specific injuries.
- Utilization Review: Assessing the medical necessity and appropriateness of treatments.
- Case Management: Coordinating care and facilitating the injured worker's return to work.
- Often Preferred by Employers/Insurers: Employers and workers' compensation insurance carriers often utilize PPOs because they can lead to better cost control, streamlined administrative processes, and potentially better outcomes due to specialized care and coordinated efforts.
- State-Specific Regulations: It's important to note that the rules for PPOs in workers' compensation vary significantly by state. Some states mandate or encourage their use, while others have specific requirements for provider choice within a PPO.
In essence, a Workers' Compensation PPO helps employers and their insurers manage the medical care component of work injury claims efficiently and cost-effectively by leveraging a network of qualified providers.
Similar Keywords:
- Preferred Provider Organization
- Health Insurance Plan
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- Managed Care
- Network Providers
- Out-of-Network
- In-Network
- Medical Benefits