Addressing Health Care Cost and Quality Ease of Navigating ...avenue.horizonblue.com/sites/default/files/Horizon... · Addressing Health Care Cost and Quality We are pleased to announce

A newsletter for Horizon Casualty Services participating health care professionals and their office staff.

Winter 2014 HorizonCasualty.com

Addressing Health Care Cost and Quality

Ease of Navigating the Health Care System

Client Updates

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Visit HorizonCasualty.com to access ourHCS Network Directory and Physician Resources.

Table of Contents

HCS Celebrates 20 Years of Success 1

From the Desk of … 2

Addressing Health Care Cost and Quality

Improving Clinical Results – 3Outcomes Focused Network Program

Using LabCorp 4

Our Commitment to Quality Standards 5

Integrated Network Approach 5

Access to Effective and Safe Care

Untangling Opioids 6

The Increasing Risks of Compounded 7Medications

Ease of Navigating the Health Care System

Avoiding Medical Bill Edits 8

Simplifying the Medical Bill Payment 8Appeal Process

Enhancing Communication with 9Quick Notes

Information at Your Fingertips 10

Changes to Our Mailing Address 10

Client Updates

Horizon Casualty Services, Inc. 12Client Listing

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HCS Celebrates 20 Years of Success!In November 2014, Horizon Casualty

Services, Inc. (HCS) marked its 20thanniversary. The company’s first clientwas the State of New Jersey Division ofRisk Management, which administersthe workers’ compensation programfor all State of New Jersey employees.HCS has grown substantially over theyears and currently has 43 percentmarket share in workers’ compensationand 24 percent market share in personalinjury protection (PIP) administrativeservices within New Jersey based onclient written New Jersey premium andnumber of insured autos respectively.

From its inception, HCS sought tobuild a medical network of doctors andother health care professionals andfacilities specializing in the delivery ofoptimal medical care to personsinjured on the job and in autoaccidents. The company also made abusiness decision to build all of its ownsystems for medical management,network services, medical billprocessing and all related transactions.This decision has enabled HCS to focusquality and precision in the services itprovides, to promote high levels ofcustomer satisfaction and to increaseoperational efficiency.

HCS has been recognized by itsclients, many of whom are large multi-national insurance companies,for its extensive innovation and highdegree of data accuracy. Today, thecompany is focused on reshaping how medical care is delivered. Thecompany has managed to createsubstantial additional value forpatients, insurers and for New Jerseyresidents overall.

Recognizing the economic impactthat devastating injury can have oninjured individuals and their families,HCS programs focus on ensuring thatappropriate care and treatment isprovided in the most effective caresetting. HCS programs also focus onconservative treatment to avoid opioidaddiction and prevent unnecessarysurgery – both of which can result insubstantial lifelong complicationsaffecting our claimants’ health andwell-being.

All of our company accomplishmentscould not have been achieved withoutour very special employees, whocontribute to our company’s successevery day, with every customer contactand transaction they perform. We alsosalute our longstanding networkparticipants, across the entire state,who are integral to the delivery ofoptimal care that helps patients be the best they can be in leadingproductive lives.

Congratulations Horizon CasualtyServices on achieving 20 years ofservice excellence.

Sincerely,

Ilene B. WachsPresidentHorizon Casualty Services, Inc.

Ilene WachsPresident, HCS

From the desk of...

Gerard Malanga, MD Horizon Casualty Services Medical Director

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I am very excited to be formallynamed HCS Medical Director. Ihave been working with HCS forover 16 years, serving as a medicalconsultant and as a member of theclinical quality improvementcommittee.

In my role as the medicaldirector, I have been workingclosely with the various staffmembers of HCS and have foundthem to be friendly, helpful andenergetic about their work.Together, we are working todevelop some exciting newprograms such as the Pain Management Medical Home (PMMH) and OutcomesFocused Network (OFN).

I believe these programs willrevolutionize the treatment ofinjured workers and will result in the best outcomes for thesepatients. These programs will be based on well-establishedscientific literature combined with coordinating the best clinicians to treat a variety of orthopedicconditions. Great emphasis isplaced on getting the patient to the right health care provider in the most efficient manner possible as well as assisting the clinicians incoordinating their care to reducemiscommunication and prolongeddisability following an injury.

As a treating physician myself, I truly appreciate a process thatcombines evidence-based medicine as well as coordinated and optimalhealth care treatment to ourpatients.

It is for these reasons that I am quite excited to provide medicalinput and leadership as theseprograms are developed.

Thus far, as I have approachedvarious physicians, physicaltherapists, psychologists and othersregarding these programs, thefeedback has been quite positive.

I look forward to having theseprograms fully developed andimplemented over this next year.

“Great emphasis is placedon getting the patient tothe right health careprovider in the mostefficient manner possibleas well as assisting theclinicians in coordinatingtheir care to reducemiscommunication andprolonged disabilityfollowing an injury.”

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Improving Clinical Results –

Outcomes Focused Network ProgramHCS has embarked on an initiative to improve the

clinical experience for patients and health careprofessionals. As an approved New Jersey Workers’Compensation Managed Care Organization, werecognize that there are many challenges in themarket today. The workforce is aging, emergingcomorbidities negatively affect worker health status,treatment and administrative costs continue to rise,medical outcomes are inconsistent and collaborationamong health care professionals is on the decline. To address these issues, HCS has developed anOutcomes Focused Network (OFN) Program.

The OFN Program currently has threecomponents:

u Pain Management Medical Home (PMMH)

u Surgical Episodes of Care (SEOC)

u Initial Treater Episode of Care (ITEOC)

Program goals include conservative management,coordination of medical care, consistent outcomes,prompt return to work, cost efficiency and 100percent in-network utilization.

PMMH is an early intervention program aimed atpreventing pain in the acute phase of an injury fromdeveloping into a chronic disability. This is achievedthrough the use of evidence-based treatmentprotocols integrated with a biopsychosocial approachthat treats mind and body, with emphasis oncollaboration among interdisciplinary care teams.

PMMH specific goals include timely return towork, avoidance of opioid prescriptions andreduction in unnecessary surgery.

SEOC seeks to provide comprehensive care before,during and after surgery. Patients undergoing a knee,shoulder or spine procedure are treated by acoordinated team of in-network physicians, facilities,anesthesiologists and other ancillary providers whoare strategically aligned to ensure patients receiveprompt, intensive treatment by the right physician inthe appropriate setting.

ITEOC is focused on convenient access, accuratediagnosis, timely referral to specialists as needed andappropriate conservative care. Patients remain activeand engaged from the start, and when necessary, arepromptly referred in-network for specialty care.

Addressing Health Care Cost and Quality

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Addressing Health Care Cost and Quality

Health care professionals that wish to participatein the OFN program must be members in goodstanding of the HCS network and meet current HCSquality standards. Physicians, physical therapists andpsychologists participating in the program mustagree to maintain HCS quality standards and complywith OFN program requirements.

One benefit of participating in the OFN program isthe use of packaged pre-certified care plans based onevidence-based medicine. When treatment isrendered in accordance with a care plan it cancontinue unhindered and without excessiveadministrative processes.

Another benefit of the OFN is the use of the onlineportal accessible to health care professionals forepisode management, communication, collaboration,education and patient monitoring. The portal alsoallows HCS to track outcomes and provide feedbackto participants.

Health care professionals will receive valuabledata analytics on patient and program performanceincluding length of episode, lost work time, claimcosts and relative performance in comparison to

similar OFN program participants. An importantfeature of the program is its strategic alignment ofproviders. This emphasis on efficiency andcollaboration transforms medical care from atransaction-based, fragmented state, to a streamlinedprocess with minimal administrative burden.Participating health care professionals will alsobenefit from increased patient volume because careis provided by a smaller, more specialized network.

Through OFN, HCS has created a model in whichall stakeholders can benefit. Patients receive the rightcare at the right time, along with comprehensiveinteractive patient education programs designed tooptimize medical outcomes. HCS clients benefit froma reduction in claim costs and lost work time. In-network OFN providers receive education,opportunities for collaboration, reducedadministrative burden, increased patient volume andfeedback on performance.

For more information about the program or toinquire about participation requirements, pleasecontact your HCS Network Relations Representativesat 1-800-985-7777.

Outcomes Focused Network Program....

Using LabCorpLaboratory Corporation of America (LabCorp),

is HCS’ exclusive participating laboratory servicescompany. Workers’ compensation claimants arerequired to use LabCorp for all laboratory servicessuch as blood and urine screenings.

Personal Injury Protection (PIP) claimants who use LabCorp for their laboratory services incurlower out-of-pocket expenses.

If your office is not enrolled with LabCorp, we encourage you to enroll. You may request enrollment information by contacting LabCorp at 1-800-631-5250.

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Integrated Network Approach

Our Commitment to Quality StandardsUtilization Review Accreditation Commission (URAC) Standards

When treating patients for work-related injuries orillnesses, referrals must be made only to HCSnetwork hospitals, ambulatory surgical centers,facilities, physicians and other health careprofessionals.

HCS network participants meet our quality andcredentialing standards and are required to becompliant with all HCS policies. Our focus is to offerworkers’ compensation claimants with the bestpossible medical care experience. To this end, HCS isembarking on a new network initiative whichconsists of facilitating the physicians’ process ofcoordinating same day surgical procedures for theirpatients. The network strategy aligns networkanesthesiologists with network ambulatory surgicalcenters providing an integrated network approach.The HCS network professionals’ expertise, coupled

with expedited medical care, helps deliver optimalmedical outcomes in the most expedient manner.

Personal Injury Protection (PIP) claimants canseek services from their physician of choice.However, we suggest that you recommend that theytreat with HCS network participants because of thenetwork physicians’ expertise in musculoskeletalinjuries and illnesses. PIP claimants who seekservices from HCS network participants incur lowerout-of-pocket expenses and increase their medicalbenefits.

The HCS medical network directory can be foundat HorizonCasualty.com under HCS NetworkDirectory.

Addressing Health Care Cost and Quality

We are pleased to announce that HCS receivedaccreditation from the Utilization Review AccreditationCommission (URAC) of its Health Utilization Management(UM) program.

URAC is a not-for-profit organization that promoteshealth care quality through its accreditation, educationand measurement programs. URAC offers a broad rangeof quality benchmarking programs and services for thehealth care industry, providing a symbol of excellencefor those organizations that obtain URAC’s seal ofapproval.

The UM program is the evaluation of medicalnecessity, appropriateness and efficiency of the useof health care services, procedures and facilities.URAC’s UM program consists of evidence-basedguidelines and other broadly recognized standardsand measures. HCS follows URAC’s UM standardsin order to ensure the patients it serves receivethe best possible care.

Obtaining URAC accreditation is another way HCSdemonstrates its commitment to the quality of its programsand services.

Access to Effective and Safe Care

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Untangling OpioidsQ. What is the issue?A. The use of addictive opioid pain relievers (OPRs)

has reached epidemic levels in the United States.The statistics reported by the Centers for DiseaseControl and Prevention tell the story. In 2010,enough OPRs were sold to medicate everyAmerican adult with a typical dose of five mg ofhydrocodone every four hours for one month.

Nearly three out of four prescription drugoverdoses are caused by OPRs. The rise inoverdose deaths in the U.S. parallels a 300 percent increase since 1999 in the sale ofOPRs. About one-half of prescription pain killerdeaths involve at least one other drug includingbenzodiazepines, heroin, cocaine and alcohol.Nonmedical use of OPRs costs insurancecompanies up to $72.5 billion annually in healthcare costs. According to the Substance Abuse and Mental Health Services Administration morethan 12 million people reported using OPRs non-medically in 2010.

Q. What do we know?A. Opioid medications are most effectively used to

treat acute pain and chronic pain caused bycancer. The efficacy of OPR use for non-cancerchronic pain is controversial because the long-term benefit is weak and the potential for seriousadverse effects is high. In low doses OPRs areeffective at relieving severe pain, suppressingcough and controlling diarrhea. When usedappropriately these drugs have many benefitsincluding improved quality of life, better overallfunctioning and faster healing. At medium and high doses the very same drugs can causeeuphoria, respiratory depression, seizures, coma and cardiac arrest. Inappropriate OPR usecan lead to addiction, dependency and death.

Most OPRs are originally obtained by prescriptionfrom a primary care physician, internal medicinephysician or dentist. However, once they areprescribed and dispensed those medications arefrequently diverted to those using them without a prescription. According to federal lawenforcement agencies, the street value for one 80 mg tablet of Oxycontin* is more than $80. The Centers for Medicare & Medicaid (CMS)report that such illegal activity costs our nationbillions of dollars each year. Trends indicate

that such practices are becoming much morecommon in the worker’s compensation industry as well.

Q. What can we do?A. The safest and most effective way to prevent

opioid abuse and addiction is to avoid prescribingthese medications. There are many safealternatives to OPRs. One approach offeredthrough Horizon Casualty Services’ OutcomesFocused Network is the Pain ManagementMedical Home. This program treats neck andback pain using a biopsychosocial approach. Non-opioid medications are combined withfunctional physical therapy and cognitivebehavioral therapy to address all aspects of pain.

Under certain circumstances the use of OPRs isappropriate and effective. To minimize the risk of abuse and addiction, the prescribing physicianmust accurately assess the patient’s condition and adhere strictly to evidence-based opioidprescribing practices. Understanding what groups are at the highest risk for abuse can help physicians treat appropriately. Factors thatcontribute to an increased risk for opioid abuse include:

u Family or personal history of substance abuse

u Frequent contact with high-risk individuals

u History of criminal activity and/or legalproblems

u History of previous problems with employers,family and friends

u History of risk-taking/thrill seeking behavior

u History of severe depression or anxiety

u Multiple psychosocial stressors

u Previous drug and/or alcohol rehabilitation

u Smoking cigarettes

u Youth

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*This document contains references to brand name prescriptionmedicines that are trademarks or registered marks of pharmaceuticalmanufacturers that are not affiliated with Horizon Blue Cross Blue Shieldof New Jersey, the Blue Cross and Blue Shield Association or Prime Therapeutics.

The Increasing Risks of Compounded Medications

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Recent occurrences of patients who have beenexposed to bacteria linked to compoundedmedications have raised patient safety concerns allover the country.

Compounding medications is the practice ofcombining, mixing or altering two or moreingredients to create a customized medication for apatient. Traditional compounding combined and/ormodified two or three different ingredients to meetan individual patient’s needs when no FDA-approvedmedication was available. However, in recent yearsthe practice of compounding medications has evolvedinto a specialty practice that provides bulkmedications in specialized strengths and dosageforms. These compounded medications are notcommercially available and must be obtained directlyfrom the compounding pharmacy.

Although states have laws that governcompounding pharmacies, the FDA does not overseethe quality standards of compounded medicationproduction nor evaluate the safety of compoundedmedications.

Increased utilization and costs of compoundedmedication creams and other topical ointments haveraised the concerns of workers’ compensation payerswho have been struggling with assessing the qualityand efficacy of the medications.

Recent studies conducted by experts conclude that:

u There is no evidence that certain topical compounds are safe or effective.

u Compounded medications increase the risks of adverse effects.

u The costs associated with compounded medications are unreasonable.

Because of the numerous infections caused bybacteria exposure linked to compoundedmedications, the FDA is seeking to regulate thecompounding of drugs that go beyond traditionalcompounding. The physician’s decision to prescribeand approve compounded drugs should be carefullyconsidered and limited to patients with unique orspecific requirements. Examples include patientswith documented allergies or the inability to swallow.Physicians prescribing compounded drugs mustperform due diligence on the safety, efficacy andadequacy of the compounded drug for eachindividual patient.

Access to Effective and Safe Care

Tools and resources are available for physicians to gaincompliance and monitor the use of OPRs. Physicians areencouraged to screen patients prior to prescribing an OPR.There are a variety of assessment tools available, including the:

u CAGE Questionnaire used to screen for alcoholism

u Opioid Risk Tool that assesses addiction risk potential

u Current Opioid Misuse Measure (COMM) that helps toidentify those patients who are currently misusing theirprescribed opioid medication.

Before issuing a prescription,physicians are encouraged to reviewthe patient’s prescription history byaccessing the New Jersey PrescriptionMonitoring Program (NJPMP) websiteat njconsumeraffairs.gov/pmp.Opioids should be prescribed for ashort course and their use should bemonitored for effectiveness. If opioidsare not effectively reducing pain otheralternatives should be considered.

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Avoiding Medical Bill Edits

Simplifying the Medical Bill Payment Appeal Process

If you disagree with the way a medical bill was processed, we encourage you to submit amedical bill payment appeal directly to HCS. A medical bill payment appeal is a formal written request to review a previously processed bill payment determination.

Appeals must be submitted in writing andinclude:

u A cover letter explaining the rationale for the appeal

u A copy of the original medical bill

u A copy of the Explanation of Payment (EOP)

HCS responds to medical bill payment appealswithin 14 days of receipt. Fax a medical appeal to 1-973-622-7265 or mail your medical appeal to:

Horizon Casualty ServicesPO Box 10175

Newark, New Jersey 07101-3175

PIP network participants should always use the bill payment appeal process prior to submitting bill payment disputes throughthe arbitration process.

Accurate coding to report medical services isessential to obtain timely and appropriatereimbursement. When coding medical bills forservices rendered by physicians, other health careprofessionals and facilities, coding practices that areconsistent with the Centers for Medicare & MedicaidServices (CMS) National Correct Coding Initiatives(NCCI) must be used.

NCCI guidelines are based on coding conventionsthat are defined in the American Association’sCurrent Procedural Terminology (CPT) Manual,national and local policies, coding guidelinesdeveloped by national societies, analysis of standardmedical and surgical practices, and a review ofcurrent coding practices. These guidelines promotenational correct coding methodologies and helpcontrol improper coding which often leads toinappropriate payment.

HCS clients use correct coding guidelines andNCCI edits to determine appropriate reimbursementof medical bill payment. Some of the NCCI edits used include:

u Appropriate use of Evaluation and Management(E&M) codes for new patients and establishedpatients. E&M codes must be selected inaccordance with the complexity of the visit.

u Incorrect CPT code combinations. Certainservices related to a surgical procedure areincluded in the payment of the global surgerypackage. These services include E&M andrelated surgical procedures performed by thesame physician for the same patient.

When medical bills are submitted with incorrectCPT procedure code combinations, only the morecomprehensive CPT code is eligible for separatereimbursement. Procedures should be reported withthe most comprehensive CPT code that describes theservices performed. For more information aboutcorrect coding and NCCI edits, log on to:cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.

Ease of Navigating the Health Care System

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Enhancing Communication with Quick Notes

A major objective in coordinating workers’compensation for injured claimants’ medical care isachieving prompt accurate diagnoses and treatmentwith timely and safe return-to-work.

Because communication between physicians, other health care professionals and nurse casemanagers is essential to meeting these objectives, for your convenience, HCS created the followingeasy-to-use patient treatment forms:

u Workers’ Compensation Patient TreatmentPlan Form. This form serves as a summary of a workers’ compensation patient’s medicalstatus, treatment plan, anticipated return-towork date and maximum medical improvementstatus.

u Weekly Physical/Occupational Therapy Plan Form. This form provides the HCSworkers’ compensation case manager withdocumentation of the patient’s functionalprogress and the therapist’s subjective andobjective assessment findings along with his/her recommendations and future treatment plan.

u Progress & Treatment StatusPsychologist/Psychiatrist Report Form. This form is used by psychologists andpsychiatrists to document a workers’compensation claimant’s medical assessment, treatment plan and estimated return-to-work date.

All forms must be completed and faxed to theassigned case manager the same day of the officevisit or the next business day.

To access these forms, please log on toHorizonCasualty.com/Physician-Resources andselect Patient Treatment Forms.

Ease of Navigating the Health Care System

Changes to our Mailing Address

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Ease of Navigating the Health Care System

Horizon Casualty Services has relocated its business office to:

Horizon Casualty Services, Inc.3 Penn Plaza East, PP-14W

Newark, NJ 07105

The mailing address for all standard United States Postal Service (USPS) correspondence has changed to:

Horizon Casualty Services, Inc.PO Box 10175

Newark, NJ 07101-3175

Please use the mailing address for all medical bill submissions, appeals and general correspondence.

Our telephone number remains the same.

If you have questions about the address change, please contact our Customer Service Department at 1-800-985-7777.

Information at Your Fingertips

Important information about HCS can be easilyaccessed by logging on to HorizonCasualty.com.

Service Offerings and Unique FeaturesHCS is one of New Jersey’s leaders in the industry

of medical management and administration ofworkers’ compensation and Personal InjuryProtection (PIP) services. The clients we serveinclude some of the largest and most sophisticatedinsurers in the country.

With medical costs on the rise, our clients demandnew collaboration models that shift the paradigmfrom the current transaction-based medicalmanagement approach to an outcomes-basedmedical management approach. To this end, HCS and its clients are embarking on new collaborationmodels aimed at providing optimal medical outcomeswhile reducing overutilization costs.

Physician ResourcesHCS developed the following reference materials

to assist you with your day to day administrativeinteractions with HCS and its clients.

u Patient Treatment Forms to assist you with communication and billing of aclaimant’s injury.

u Office Manual for Participating Physicians & Other Health Care Professionals whichprovides basic guidelines regarding how to do business with HCS and its clients.

u HCS Client Listing to help you identify the insurance companies that are doing business with HCS.

These reference materials enhance thecommunication between your office and HCSresulting in administrative efficiencies.

HCS offers physicians and other health care professionals and facilities easy navigation and access toimportant information about the company’s service offerings and unique features, physician resources,newsletter publications, and access to a specialized network of hospitals, ambulatory surgery centers,physicians and other health care professionals.

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NewsletterThe annual edition of HCS Express provides

network physicians and other health careprofessionals and facilities with the latest informationregarding HCS’ new initiatives, industry updates and administrative best practices. Copies of the HCS Express newsletter are available online for your convenience.

HCS Network DirectoryWorkers’ compensation patients must be referred

to HCS network hospitals, physicians and otherhealth care professionals for work–related injuriesand illnesses.

Personal Injury Protection (PIP) injured claimantsare encouraged to use HCS network participantsbecause of their expertise in the treatment ofmusculoskeletal injuries and focus on optimaloutcomes at the lowest cost.

To access a complete directory of HCS networkphysicians and other health care professionals andfacilities, please visit HorizonCasualty.com andselect HCS Network Directory. You may search bygeographical location or by a group or facility name.

For additional information please visit our websiteat HorizonCasualty.com.

CorrectionIn our Spring/Summer 2013 newsletter we

indicated that reimbursement for services renderedby a non-physician assistant surgeon is calculated at17.5 percent of the HCS allowed amount for eachprocedure. The correct non-physician assistantsurgeon reimbursement calculation is at 17 percentof the HCS allowed amount for each procedure.

Ease of Navigating the Health Care System

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Horizon Casualty Services, Inc.Client Listing

The Hartford Insurance Company4Fitchburg Mutual Insurance Company4Hartford Accident and Indemnity Company4Hartford Casualty Insurance Company4Hartford Fire Insurance Company 4Hartford Insurance Company of the Midwest4Hartford Underwriters Insurance Company4Twin City Fire Insurance Company

Liberty Mutual Insurance Group4America First Insurance Company4Colorado Casualty Insurance Company4Consolidated Insurance Company4Employers Insurance Company of Wausau4Excelsior Insurance Company4The First Liberty Insurance Corporation4Golden Eagle Insurance Corporation4Hawkeye-Security Insurance Company 4Helmsman Management Services, Inc.4Indiana Insurance Company4Liberty Insurance Company of America4Liberty Insurance Corporation4Liberty Lloyd’s of Texas Insurance Company4Liberty Mutual Fire Insurance Company4Liberty Mutual Insurance Company4Liberty Mutual Managed Care, LLC4Liberty Northwest Insurance Corporation4LM Insurance Corporation4Mid-American Fire and Casualty Company4The Midwestern Indemnity Company4Montgomery Mutual Insurance Company4The Netherlands Insurance Company4Peerless Indemnity Insurance Company4Peerless Insurance Company4Wausau Business Insurance Company4Wausau General Insurance Company4Wausau Underwriters Insurance Company

New Jersey Manufacturers Insurance Company4New Jersey Casualty Insurance Company4New Jersey Indemnity Insurance Company4New Jersey Re-Insurance Company

Selective Insurance Company4Selective Auto Insurance Company of New Jersey4Selective Insurance Company of America4Selective Insurance Company of New England4Selective Insurance Company of New York4Selective Insurance Company of South Carolina4Selective Insurance Company of the Southeast4Selective Way Insurance Company

State of New Jersey

Zurich North America Insurance Company4American Guarantee and Liability Insurance

Company4American Zurich Insurance Company4Assurance Company of America4Colonial American Casualty and Surety Company4Empire Fire and Marine Insurance Company4Empire Indemnity Insurance Company4The Fidelity and Deposit Company of Maryland4Maryland Casualty Company4Maryland Insurance Company4Northern Insurance Company of New York4Steadfast Insurance Company4Universal Underwriters Insurance Company4Universal Underwriters Life Insurance Company4Universal Underwriters of Texas Insurance Company4UUBVI, Limited4Zurich American Insurance Company4Zurich American Insurance Company of Illinois

This Horizon Casualty Services, Inc. client list is accurate as of December 1, 2014.

Workers’ Compensation Administrative Services

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The Hanover Insurance Group4Allmerica Financial Alliance Insurance Company 4Allmerica Financial Benefit Insurance Company 4Citizens Insurance Company of America4The Hanover Insurance Company4Hanover New Jersey Insurance Company4Massachusetts Bay Insurance Company

Liberty Mutual Insurance Group4Liberty Insurance Corporation4Liberty Mutual Fire Insurance Company4Liberty Mutual Insurance Company 4Liberty Mutual Mid-Atlantic Insurance Company

This Horizon Casualty Services, Inc. client listing is accurate as of December 1, 2014.

New Jersey Manufacturers Insurance Company4New Jersey Casualty Insurance Company4New Jersey Indemnity Insurance Company4New Jersey Re-Insurance Company

All medical bills should be mailed to:Horizon Casualty Services, Inc.

PO Box 10175Newark, NJ 07101-3175

Horizon Casualty Services, Inc.Client Listing

Personal Injury Protection (PIP) Administrative Services

3 Penn Plaza East, PP-14WNewark, New Jersey 07105.

A newsletter for Horizon Casualty Services participating health care professionals and their office staff.

Horizon Casualty Services, Inc., 3 Penn Plaza East, PP-14W, Newark, NJ 07105

Editor: Judith Sherman Managing Editor: Terry Stanulis Director: Daisy Chan Design and Layout: Jose AlarconKaren Formal

Services and products may be provided by Horizon Casualty Services, Inc., P.O. Box 10175, Newark, NJ 07101-3175, a subsidiary of Horizon Blue Cross Blue Shield of New Jersey.Horizon Casualty Services and Horizon Blue Cross Blue Shield of New Jersey are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2014 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105. CMC0006705 (1214)