Health Plans
Backed by experienced claims and customer service professionals, seasoned medical management, and a cutting-edge claims administration platform, The CHP Group delivers seamless access to complementary and alternative medicine (CAM) services while maintaining the highest levels of quality. Our panel of credentialed providers understands the nature of insurance-based care and the need to deliver services cost-effectively.
CAM services can help make life more enjoyable. Studies have shown that, when compared with conventional medicine alone, CAM services can reduce hospital admissions by 60% and lower pharmaceutical costs by 85%, with consistently higher patient satisfaction rates.
The CHP Group CAM services keep providers and patients on the same page. We provide, credential, and contract with a network of providers which includes the following disciplines: acupuncture, chiropractic, massage therapy, and naturopathic medicine.
Claims Processing and Payment
Individual CHP providers send claims for services rendered directly to The CHP Group. CHP will apply the negotiated CHP fee schedule and employer group benefit limitations and exclusions to the claims. Payments for services can be sent from CHP directly to the practitioner.
Utilization Management
The leader in managing complementary and alternative medicine services, CHP’s utilization management helps you maximize your CAM services dollars. A strong believer in evidence-based accountability, CHP’s proprietary UM technology focuses on the latest benchmarking data for unit costs, utilization metrics, and evidence-based clinical protocols for care delivered to covered employees. Through an integrated approach to managing cost and quality, CHP can help purchasers improve outcomes and increase employee productivity.
Developed in cooperation with network practitioners, CHP’s Utilization Management policy is NCQA-compliant and is overseen by senior CHP clinical managers. UM procedures are transparent to employees and unobtrusive to practitioners. UM denials are made by licensed practitioners. At any time, CHP clinical management staff is available to providers and members to discuss UM processes and decisions. Appeals are handled promptly and in a manner that is fair to patients, practitioners, and payers.
Targeted Communications
To enhance accountability and control outlier performance, CAM services include proactive feedback of actionable information to each provider. Personalized communication to patients alerts them to the state of their benefit limit. Keeping providers and patients informed regarding benefits significantly increases the value of our CAM services.