A: CHN is a regional network in Northeastern Ohio and Northwestern Pennsylvania of leading hospitals, physicians and other health care providers who have contracted with employers and insurers to deliver and better manage the health benefits of our patients. As a patient of a CHN physician or at a CHN hospital, you will receive the highest quality and clinically effective care possible. CHN is committed to improving health in the communities we serve, in addition to measuring and reporting on the quality, outcomes and satisfaction of care delivered.

A: There are a number of ways to determine if your physician is participating in CHN:

• Ask if s/he is participating in CHN.
  
• Current information should be accessible from the payor's Member Services department. Please refer to your membership identification card for the appropriate phone number.
  
• CHN contracted payors publish a provider directory which is periodically updated. Obtain a current copy of the payor’s Directory from your respective payor’s Member Services Department.
  
• Query the CHN Practitioner Directory on our Web site (www.chnetwork.com) to locate a provider participating in CHN, and to find out the hospital(s) where s/he has admitting privileges.
  

A: A contracted payor is an insurance company, self-funded employer group or third party administrator that contracts with CHN to provide access to our provider network. For additional information on CHN contracted payors, please refer to the CHN Payor Fact Sheets.

A: CHN does not pay claims to providers, therefore claims questions should be directed to the Member Services department of the respective payor. The Member Services department typically requires the following information in order to answer your questions:

• Patient name
  
• Patient or member identification number
  
• Provider name
  
• Date of service
  

A: Incorrect claims questions and issues should be forwarded to the Member Services department of your respective payor.

A: In general, laboratory and/or radiology services can be provided in any in-network physician office. Laboratory and/or radiology services can also be provided in hospital laboratories, in addition to hospital affiliated- laboratories or radiology centers. Please verify with the health plan when authorizing or precertifying these type of services. Physicians can also refer patients to any CHN hospital-affiliated laboratories or radiology centers.

A: CHN has participating organizations in the following Ohio counties: Cuyahoga, Summit, Lorain, Mahoning, Trumbull, Erie, Wayne, Medina, Stark and Ashtabula. There is one member organization in Erie, Pennsylvania.

A: Definitions from Source.

Health Maintenance Organization (HMO)-- A type of plan that controls health care expenses by making cost-saving arrangements with physicians, hospitals and other health care practitioners. Usually, HMOs offer reduced out-of-pocket costs to members who have their care coordinated by a primary care physician who participates in their network.

Point-of-Service Plan(POS)-- A commercial insurance plan which combines elements of HMOs and PPOs to balance cost controls with the enrollee's freedom of choice. Enrollees select a primary care physician from a network of physicians contracted to the plan. The cost to the enrollee for care provided by a network practitioner is very low or nothing. Enrollees may obtain care from out-of-plan practitioners but at a significantly higher cost share.

Preferred Provider Organization (PPO)-– A managed care plan in which you use doctors, hospitals, and providers that belong to the network. The practitioner agrees to accept negotiated fees in return for prompt payment and a certain volume of patients. Members may seek care from non-participating practitioners but generally are financially penalized for doing so by the loss of discounted fees and may be subject to co-payments and deductibles.