CHN PPO’s Certifications & Regulatory Approvals in New Jersey
- Organized Delivery System (ODS) in New Jersey.
- Workers’ Compensation Managed Care Organization (WCMCO) in New Jersey.
- CHN PPO operates a New Jersey Voluntary Provider Network, included as part of its specialty network offerings.
With over 35 years of experience in New Jersey, our parent company Medlogix and CHN PPO are deeply rooted in the state's challenging insurance landscape.
New Jersey is among the most complex and highly regulated states to navigate claims management. Our experience in New Jersey and other demanding state environments helped us develop highly sophisticated solutions that can be applied seamlessly in other markets.
Our success in these challenging regulatory states paved the way for our national expansion.
Our extensive regional and nationwide network of physicians provides our clients with thousands of state-specialty combinations to match their cases.
CHN PPO’s network includes over 228,000 provider locations, with a strong concentration in New Jersey
- CHN PPO serves insurance carriers, TPAs, Joint Insurance Funds, counties, municipalities, and school boards in New Jersey.
- CHN PPO’s providers are thoroughly vetted and credentialed, with state-specific compliance standards to minimize regulatory risk in New Jersey.
- The New Jersey Voluntary Provider Network focuses on high-cost procedure management and specialized care.
Claims & Bill Review Services in NJ
- CHN PPO’s MyMedlogix system is designed for full integration with New Jersey claims workflows.
- MyMedlogix applies state-specific fee schedules prior to the PPO rate application process.
- For out-of-network claims, CHN PPO and Medlogix use bill negotiation services that utilize UCR, Medicare benchmarks, and utilization history to reduce costs.
- Signed Letters of Acceptance (LOAs) are required and retained for each negotiated bill.
We are the first company in New Jersey to have their plan approved by the NJ Department of Banking and Insurance, a testament to our pioneering approach and dedication to compliance.
- Our senior executives actively advise the NJ PIP TAC Committee.
- Medlogix has provided training and guidance to insurance carriers, regulators, arbitrators, and providers on compliance and best practices.
- We offer a full complement of NJ Precertification Services within AICRA regulations and carrier plan specific rules approved by the NJ State Department of Banking and Insurance.
