Our PPO Network
Our network is focused on providing claimants with the right treatment, by the right professionals, at the right price.
Unlike a typical health network, our physicians are specifically contracted for both workers' compensation and personal injury protection (PIP). They are required to see patients the same day of injury, if necessary, without an appointment. Our network physicians know the importance of timely and accurate diagnosis and treatment. Emphasis on a prompt, safe return to work and/or full functionality enables claimants and their insurers to achieve desired mutual benefits.
Outcomes-Focused Network
Our Outcomes-Focused Network consists of specialists, physical therapy professionals and surgical centers that closely collaborate to deliver medical care to injured workers using evidence-based medical guidelines. The Outcomes-Focused Network keeps patients engaged in their medical treatment so that they understand their condition and play an active role in their recovery. The program helps to decrease the use of opioid medications, resulting in faster recovery without the high cost and high risk of addiction.
Our services enable workers’ compensation and automobile insurers to achieve excellent financial results. Our medical directors are practicing doctors, and HCS is URAC-accredited. More than 99 percent of New Jersey hospitals are in our network and our network is directly contracted, not leased. HCS also has an extensive ambulatory surgery network and is contracting with affiliated anesthesia groups.
Services include:
- Automated data analytics
- Dedicated account management
- Dedicated IT, with fully integrated, proprietary systems
- Legal representation of provider contracts and rates
- Medical bill processing, tracking, monitoring and payment
- Resolution of provider inquiries
- Systems and data security under Horizon Blue Cross Blue Shield of New Jersey
- Web-based client access
HCS also offers industry-leading services to increase network utilization and efficiency for insurance company nurses and adjusters. These services include:
- Appointment scheduling and tracking services
- Network participant look-up tool
- Extraction of key data elements from medical reports
- Medical management through the Outcomes-Focused Network participants
- Referral program
- Treatment/return-to-work tracking within specific diagnosis and associated national medical guidelines
Doctors and Other Health Care Professionals
Our network consists of doctors and other health care professionals who specialize in treating the types of injuries that result from work-related and automobile accidents. Our contracted medical professionals understand our clients’ expectations and continually seek to deliver optimal treatment and return-to-work outcomes.
In addition, some of our doctors participate in the HCS Outcomes-Focused-Network, which focuses on care delivery using evidence-based medical guidelines. Care is delivered conservatively, avoiding the use of opioids and unnecessary surgery.
Facilities
The HCS network has a broad base of New Jersey (and contiguous counties in surrounding states) acute care hospitals, rehabilitation hospitals, ambulatory surgical centers, skilled nursing/sub-acute facilities, mental health & substance abuse facilities, and extended care facilities. We are increasingly contracting with anesthesia groups for care delivered at in-network hospitals and ambulatory surgery centers.
Ancillary Network
The HCS network includes:
- Diagnostic imaging centers
- Durable medical equipment (DME) providers
- Electrodiagnostic testing (EMG/nerve conduction study) specialists
- Physical therapy & occupational therapy centers
- Prosthetics/orthotics specialists
- Medical transportation providers
- Home health/hospice providers
- Dialysis centers
- Specialized musculoskeletal drug formulary and integrated quality and utilization management program provided by Prime Therapeutics LLC
- Specialty ancillary providers for those cases requiring chronic care management
Prime Therapeutics LLC is an independent company providing pharmacy benefit management services for Horizon BCBSNJ members.