NJ Auto Physician Treatment Plan

Please complete this treatment plan form. You may print the form and fax to the UM Department at CHN Solutions at 877-254-9572. All of the supporting medical records must be included with the treatment plan. Or you may complete this treatment plan form and email it along with all of the supporting medical records to our mailbox at CHNUM@CHN.com and it will be forwarded to the UM Department. Should you have any questions, please contact CHN Solutions at 800-293-9795.


NJ Auto Physician Treatment Plan Form

NJ Auto Physician Treatment Plan Form (Excel file)