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About HCS

Horizon Casualty Services, Inc. (HCS), a subsidiary of Horizon Blue Cross Blue Shield of New Jersey, is an approved New Jersey workers’ compensation managed care organization (WCMCO) and provides personal injury protection services (PIP) for automobile insurers.

Our mission is to provide managed medical care services that generate optimal medical and return-to-work outcomes, while containing workers’ compensation and personal Injury protection (PIP) costs.

Workers’ compensation insurers, self-insured employers and automobile insurers and their claimants can benefit significantly by using HCS. We provide an array of administrative, medical network and medical management services to achieve optimal medical and return-to-work outcomes. HCS helps claimants return to work, and contain workers’ compensation and PIP costs.

Services include:

  • Publication and distribution of the network directory
  • Annual demographic and provider affiliation verification
  • Referral of claimants to in-network facilities for their entire course of treatment of the injury
  • Utilization Management (UM)
  • Customer Service for questions about reimbursement and precertification
  • Resolution of complaints and appeals
  • Medical bill processing
  • Issuance of payment checks on behalf of clients
  • Appointment Scheduling for certain diagnostic procedures

The HCS network includes:

  • Initial treating physicians (initial treaters)
  • Specialists
  • Hospitals
  • Physical therapy centers
  • Ambulatory surgical centers (ASCs)
  • Urgent Care Providers
  • Diagnostic centers
  • Sub-acute and skilled nursing facilities
  • Home care providers
  • Durable medical equipment (DME) providers
  • Pharmacies
  • Laboratory services providers
  • Other services and health care professionals

Initial treaters function as Care Coordinator Physicians as defined in New Jersey workers’ compensation managed care organization regulations. Initial treaters have a key role in the HCS program because they coordinate the medical care that patients receive. In most cases, initial treaters specialize in family practice, internal medicine or occupational medicine.