Predetermination for Medical Necessity

Predetermination for medical necessity is the responsibility of the ordering physician. However, it is up to the Employee Health Plan (EHP) member’s benefit to remind their physician that this is a requirement so that claims payment issues can be avoided.
                                                                                                     
If you have questions pertaining to predetermination issues, CHN Care Management business hours are from 8 a.m. to 4:30 p.m. EST, Monday through Friday. If an urgent situation occurs, a CHN Care Manager is on call after standard business hours and can be reached by calling 216-986-1050 or toll-free at 1-888-246-6648.