Voluntary Network Services

Procedure for Durable Medical Equipment, Radiology & Diagnostic Imaging, and Electrodiagnostic Services

Description

CHN Solutions makes available to its automobile insurance customers and their insureds conveniently located, high quality services for durable medical equipment, radiology, pharmacy, and electrodiagnostics. Use of the CHN Solutions allows insureds to extend their benefit dollar and avoid certain co-pays which are referenced within the individual policies which address the CHN Solutions plan.

Notification

The insurance carrier at the time of claim will advise the insured of the availability of the CHN network services and discuss the benefits addressed above. Each insurance carrier utilizing the CHN Solutions plan will have available a hard copy listing of the CHN network resources which are available in all 21 New Jersey counties. The insurance carrier will have available the 1-800-293-9795 customer service telephone number where an insured can call and obtain a conveniently located network resource. CHN will make available to the insurance carrier the CHN website where either the carrier or an insured can easily do a search of our network resources to find the most convenient location.

CHN will also advise the injured insured's physician that there is a provision for voluntary utilization of the above network resources in CHN's initial physician letter describing the entire precertification process. References to CHN's website and customer service information are also available within the context of that notification letter.

Durable Medical Equipment and Supplies

When the treating provider prescribes durable medical equipment or supplies (braces, supports, bandages, TENS units, whirlpools, etc.), and CHN has determined they are medically necessary, the injured person will be encouraged to utilize the services of CHN's network. The injured person should call 1-800-293-9795 to speak with a representative in CHN's precertification department who will coordinate the referrals. The DME specialist will coordinate the referrals and order the supplies that will be delivered to his or her home.

Cost benefit analysis for rental versus purchase will be conducted so that the program remains cost effective. All bills for durable medical equipment sales and rental will flow through CHN for processing and will be submitted to the insurance carrier. Policy co-pays for durable medical equipment will be waived when the insured utilizes the CHN DME program.

Radiology and Diagnostic Centers

When the treating provider prescribes diagnostic tests to confirm a diagnosis and/or monitor the progress of treatment, once the test has been determined to be medically necessary (where applicable), the injured insured will be encouraged to utilize CHN's network of radiology and diagnostic centers. The injured insured should identify a conveniently located center and make an appointment.

When a bill is submitted for payment for a radiologic test or procedure that was performed at a center in the CHN network, no service specific co-payments will be applied as afforded in the automobile policy for in-network voluntary utilization. Such tests may include:

• X-ray studies
• Computer assisted tomograms (CT, CAT scan)
• Magnetic resonance imaging (MRI)
• Angiograms
• Myelograms
• Venograms
• Videofluroscopy
• Ultrasound and duplex scans
• Nuclear medicine tests

Electro-diagnostic Centers

When the treating provider prescribes diagnostic tests to confirm a diagnosis and/or monitor the progress of treatment, once the test has been determined to be medically necessary (where applicable), the injured insured will be encouraged to utilize CHN's network of electro-diagnostic centers. The injured insured should identified a conveniently located center and make an appointment.

When a bill is submitted for payment for an electrodiagnostic test or procedure that was performed at a center in the CHN network, no service specific co-payments will be applied as afforded in the automobile policy for in-network voluntary utilization. Such tests may include:

• Brain audio evoked potentials (BAEP)
• Brain evoked potentials (BEP)
• Electroencephalogram (EEG)
• H-reflex studies
• Needle electromyography (EMG)
• Nerve conduction velocity (NCV)
• Somatosensory evoked potential (SSEP)
• Visual evoked potential (VEP)

Physician and Hospital Provider Networks

Under The Auto Reform Act injured persons may seek and receive treatment with any licensed (or certified) provider. In the event that the injured person is in need of the services of a healthcare provider, for either primary care or for specialty services, the individual is encouraged to review the list of providers in CHN's network. The providers in CHN's network have been reviewed and credentialed, and dedicated to the injured person's treatment and speedy return to good health.