1997 DIRECTORY OF MANAGED CARE PROVIDERS

New Jersey
Admar Med Network
1551 N. Tustin Ave., Suite 300, Santa Ana, Calif. 92705; 714-953-9600; fax: 714-953-6309
Staff/Facilities*
Primary practitioners2,094
Specialists5,304
Hospitals67
Users
Employees & dependents15,034
Operational date: January 1978.
Service area: New Jersey: 21 counties.
**Includes leased providers/facilities.
See Admar Med Network consolidated listing under California.
AMERICAID New Jersey Inc.
115 Christopher Columbus Drive, Suite 300, Jersey City, N.J. 07302; 201-946-6875; fax: 201-524-9804
Staff/Facilities
Primary practitioners691
Board-certified38%
Specialists2,611
Hospitals36
Pharmacies1,850
Primary care locations1,382
Users
Medicaid10,397
Total10,397
Revenues
First-half 1997$10,296,704
1996$14,166,403Operational date: February 1996.
Licensed in: New Jersey.
Service area: New Jersey: Atlantic, Essex, Middlesex, Monmouth, Ocean, Passaic and Union counties.
Rating options: Community rating by class.
Officers: Dr. Lorenzo Childress Jr., interim president/CEO; Dr. Richard Newman, medical director; Theodore M. Wille, COO; Kathleen K. Toth, vp-finance.
See Americaid Community Care consolidated listing under Virginia.
AmeriHealth
HMO Inc.
8000 Midlantic Drive, Suite 333, Mount Laurel, N.J. 08054; 609-778-6500;
fax: 609-778-6550
Staff/Facilities
Primary practitioners5,306
Board-certified89%
Patients/practitioner18.6
Specialists18,952
Hospitals165
Users*
Employer/payer groups6,905
Single coverage21,205
Family coverage19,734
Employees & dependents83,494
Medicare10,931
Medicaid23,543
Total114,611
Revenues
First-half 1997$53,955,578
1996$68,268,635Parent: Independence Blue Cross.
Operational date: January 1982.
Licensed in: Delaware, New Jersey, Pennsylvania.
NCQA one year accredited.
Model type: IPA.
For profit.
Service area: Delaware; New Jersey; Pennsylvania: Berks, Bucks, Chester, Delaware, Lancaster, Lehigh, Montgomery and Philadelphia counties.
Member of HMO Blue USA. Contracts with Green Spring of Eastern Pennsylvania for mental health in 43 states; Davis Vision for vision in 43 states.
Services: General medical, dental, vision, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications.
Rating options: Community rating by class.
Offers self-insured products.
Point-of-service contracts: 12.2% of members are enrolled.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: Dr. Richard Gilfillan, general manager; Linda Taylor, Randall Miller, vps-sales/marketing; Martin Brill, vp-finance; Glenn Chong, vp-provider relations.
Contact: Colleen Kelly.
**As of November 1997.
AnciCare PPO
3700 Lakeside Drive, Suite 401, Miramar, Fla. 33027-3225; 800-414-4674; fax: 305-826-7482
Specialty: workers compensation/medical diagnostic imaging
Staff/Facilities
Primary practitioners84
Hospitals37
Service area: New Jersey: Atlantic, Bergen, Burlington, Camden, Cumberland, Essex, Hudson, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset and Union counties.
See AnciCare PPO consolidated listing under Florida.
Beech Street Corp.
173 Technology, Irvine, Calif. 92618; 800-233-2478 or 714-727-1353; fax: 714-727-1319
Staff/Facilities
Primary practitioners2,187
Specialists6,999
Hospitals62
Users: Group Health
Single coverage15,541
Family coverage60,813
Employees & dependents155,410
Users: Workers Compensation
Single coverage7,449
Total Users162,859
Operational date: 1992.
Service area: New Jersey: 21 counties.
See Beech Street Corp. consolidated listing under California.
Blue Select
3 Penn Plaza E., Newark, N.J. 07105; 973-466-4000
Staff/Facilities
Primary practitioners8,033
Specialists12,750
Hospitals66
Users: Group Health
Single coverage40,556
Family coverage58,005
Employees & dependents231,500
Ownership: Blue Cross & Blue Shield of New Jersey.
Operational date: January 1992.
Not for profit.
AAHC/URAC accreditation status: Health Utilization Management Standards.
Service area: New Jersey: statewide; Pennsylvania: Bucks, Chester, Delaware and Montgomery counties and the Philadelphia metropolitan area.
Services: General medical, vision, prescription drug, mental health. Services available unbundled. Individual enrollment is allowed.
Compensation: Negotiates hospital charges by per diem; is compensated by employers/payers; charges flat fee per employee.
UR: Standard procedures. UR provided by outside contractors.
Officers: William Marino, president/CEO; Robert Marino, senior vp-market divisions; Francis Fee, vp-corporate/major accounts; Dr. Michael McGarvey, chief medical officer; Robert Pures Sr., vp-administration/CFO.
CCN
5251 Viewridge Court, San Diego, Calif. 92123; 800-247-2898; 619-278-1262
Staff/Facilities
Primary practitioners1,299
Board-certified75.4%
Patients/practitioner1.3
Specialists2,969
Hospitals40
Users: Group Health
Employer/payer groups56
Employees & dependents2,425
Users: Workers Compensation
Employer/payer groups3
Total Users*2,425
Service area: New Jersey: 23 counties.
Services: General medical, mental health, workers compensation, ancillary services.
**Does not include workers compensation users.
See CCN consolidated listing under California.
CNA Managed Care-North Jersey
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners6,808
Hospitals32
Service area: New Jersey: North Jersey.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-South Jersey
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners3,066
Hospitals24
Service area: New Jersey: South Jersey.
See CNA Managed Care PPO consolidated listing under Illinois.
ChiroSource Inc.
P.O. Box 130, Clayton, Calif. 94517; 510-672-5333; fax: 510-672-6657
Specialty: chiropractic
Staff/Facilities
Primary practitioners38
Service area: New Jersey: statewide.
See ChiroSource Inc. consolidated listing under California.
CIGNA HealthCare of New Jersey Inc.-Southern New Jersey
1 Beaver Valley Road, Suite CHP, Wilmington, Del. 19803; 302-477-3700; fax: 302-477-3708
Staff/Facilities
Primary practitioners823
Board-certified74%
Patients/practitioner45.9
Specialists1,749
Hospitals25
Pharmacies643
Users
Employer/payer groups592
Total37,803Operational date: December 1985.
Licensed in: New Jersey.
NCQA fully accredited.
Model type: IPA.
Service area: New Jersey: Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Mercer, Ocean and Salem counties.
Point-of-service contracts: 64.2% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: Vince Sobocinski, general manager; Dr. Robert Mogul, medical director; Patrick Wormser, assistant vp-business decision support; Charlene Renollet, director-Healthplan operations; Thomas Garvey, assistant vp-network management.
Contact: Vicki Williamson.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA HealthCare of Northern New Jersey Inc.
100 Enterprise Dr., Suite 610, Rockaway, N.J. 07866; 201-328-4200; fax: 201-328-7220
Staff/Facilities
Primary practitioners2,541
Board-certified80.5%
Patients/practitioner68.6
Specialists5,298
Hospitals37
Pharmacies1,461
Users
Employer/payer groups1,676
Total174,471Operational date: March 1988.
Licensed in: New Jersey.
NCQA fully accredited.
Model type: IPA.
Service area: New Jersey: Bergen, Essex, Hudson, Hunterdon, Middlesex, Monmouth, Morris, Passaic, Somerset, Sussex, Union and Warren counties.
Point-of-service contracts: 83.5% of members are enrolled.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: Thomas Garvey, assistant vp-network management; Kurt Weimer, general manager; Karen Lerner, assistant vp-marketing; Dr. Henry P. Schuemer, medical director; Charlene Renollet, director-Healthplan operations.
Contact: Diane Padewski.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA HealthCare of Northern New Jersey Inc.-COMED
100 Enterprise Dr., Suite 610, Rockaway, N.J. 07866; 201-328-4200; fax: 201-328-7220
Staff/Facilities
Primary practitioners3,083
Board-certified78.1%
Patients/practitioner18.6
Specialists5,980
Hospitals62
Pharmacies2,084
Users
Employer/payer groups771
Total57,399Operational date: August 1978.
Licensed in: New Jersey.
NCQA fully accredited.
Model type: IPA.
Service area: New Jersey: statewide.
Point-of-service contracts: 5.4% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: Kurt Weimer, general manager; Charlene Renollet, director-Healthplan operations; Thomas Garvey, assistant vp-network management; Karen Lerner, assistant vp-marketing; Dr. Henry Schwerner, medical director.
Contact: Diane Padewski.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA PPO-Northern New Jersey
Rockaway 80 Corporate Center, 100 Enterprise Dr., Suite 610, Rockaway, N.J. 07866; 201-328-4200; fax: 210-328-7220
Staff/Facilities
Primary practitioners1,946
Board-certified80.3%
Patients/practitioner71.2
Specialists4,356
Hospitals49
Users: Group Health
Employer/payer groups611
Total Users138,589
Operational date: January 1993.
Service area: New Jersey: Bergen, Essex, Hudson, Hunterdon, Middlesex, Monmouth, Morris, Passaic, Somerset, Sussex, Union and Warren counties.
Officers: Thomas Garvey, assistant vp-network management; Patrick Wormser, assistant vp-business decision support; Karen Lerner, assistant vp-marketing; Kurt Weimer, general manager; Dr. Henry P. Schuemer, medical director.
Contact: Michael C. Kelly, 860-726-3794.
See CIGNA HealthCare PPO consolidated listing under Connecticut.
CIGNA PPO-Southern New Jersey
1 Beaver Valley Road, Suite CHP, Wilmington, Del. 19803; 302-477-3700; fax: 302-477-3708
Staff/Facilities
Primary practitioners809
Board-certified73.2%
Patients/practitioner49.6
Specialists1,992
Hospitals35
Users: Group Health
Employer/payer groups435
Total Users40,176
Operational date: January 1993.
Service area: New Jersey: Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Mercer, Ocean and Salem counties.
Officers: Vince Sobocinski, executive director/general manager/sales director/market manager; Dr. Robert Mogel, medical director; Lou Marrifino, provider relations manager; Laura Bowman, planning/analysis-medical economics.
Contact: Andrew Green, 860-726-3586.
See CIGNA HealthCare PPO consolidated listing under Connecticut.
CompSource Inc.
33 Washington St., Newark, N.J. 07102; 973-622-7103; fax: 973-622-7353
Specialty: workers comp
Staff/Facilities
Primary practitioners800
Board-certified99%
Specialists1,000
Hospitals71
Users: Workers Compensation
Employer/payer groups1,200
Single coverage140,000
Total Users140,000
Ownership: Blue Cross & Blue Shield of New Jersey.
Operational date: January 1996.
For profit.
Service area: New Jersey: statewide.
Services: Prescription drug, workers compensation. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem; is compensated by employers/payers, insurers, TPAs; charges flat fee per employee, by percent of savings, by percent of services by doctors/hospitals.
UR: Standard procedures. UR provided by the PPO.
Officers: Ilene Wachs, president; Dr. John J. Sonzogni, medical director; Gracemary Bush, director-managed care; John Oliveira, director-marketing/operations.
Contact: John Oliveira.
Consumer Health Network
371 Hoes Lane, Piscataway, N.J. 08807; 732-562-0888; fax: 732-562-9616
Staff/Facilities
Primary practitioners4,686
Specialists5,359
Hospitals117
Users: Group Health
Employer/payer groups850
Employees & dependents750,000
Users: Workers Compensation
Employer/payer groups172
Single coverage200,000
Total Users950,000
Ownership: Complete Management Inc.
Operational date: October 1988.
For profit.
AAHC/URAC accreditation status: Health Network Standards.
Service area: Connecticut: statewide; New Jersey: statewide; New York: Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk and Westchester counties.
Contracts with Mental Health Consultants Inc. for mental health in New Jersey.
Services: General medical, mental health, workers compensation. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, discount off customary rates, DRGs; is compensated by employers/payers, insurers, TPAs; charges flat fee per employee, by percent of savings.
UR: Standard procedures including IMEs, functional capacity exams and return-to-work programs. UR provided by the PPO and outside contractors.
Officers: Leonard V. Weinman, president; Mary Ann Nagy, CFO/COO; Erna Rappaport, vp-utilization/quality management; Marlene Whelan vp-network development; John Bisbee, vp-sales/marketing.
Contact: John Bisbee.
CorVel Corp.
1920 Main St., Suite 1090, Irvine, Calif. 92714; 714-851-1473; fax: 714-851-1469
Staff/Facilities
Primary practitioners1,486
Board-certified85%
Specialists5,520*
Hospitals100
Service area: New Jersey.
**Includes ancillary providers.
See CorVel Corp. consolidated listing under California.
Devon Health
Services Inc.
900 E. Eighth Ave., Suite 200, King of Prussia, Pa. 19406; 800-431-2273;
fax: 610-768-4526
Staff/Facilities
Primary practitioners2,575
Specialists7,999
Hospitals60
Service area: New Jersey: statewide.
See Devon Health Services Inc. consolidated listing under Pennsylvania.
Family Choice Health Alliance Inc.
401 Hackensack Ave., Ninth Floor, Hackensack, N.J. 07601; 201-487-6001; fax: 201-487-1116
Staff/Facilities
Primary practitioners2,031
Board-certified91%
Specialists6,848
Hospitals41
Total Users135,000
Ownership: MDM Inc.
Operational date: 1990.
For profit.
Service area: New Jersey: Atlantic, Bergen, Burlington, Camden, Cape May, Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset, Sussex, Union and Warren counties.
Services: General medical, mental health. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by discount off customary rates; is compensated by employers/payers; charges flat fee per employee, by percent of savings.
UR: Preadmission review, precertification. UR provided by outside contractors.
Officers: Richard Michaelson, president; Sheldon Ashley, chairman-advisory board; Karen Piotti, director-marketing/sales; Jo-Carol Leonard, director-provider relations; Tony Mercaldi, director-management information systems.
Contact: Karen Piotti.
First Option
Health Plan
of New Jersey Inc.
3501 State Highway 66, Neptune, N.J. 07754; 732-918-6700; fax: 732-918-6407
Staff/Facilities
Primary practitioners3,286
Board-certified54%
Patients/practitioner59
Specialists7,936
Hospitals60
Pharmacies1,858
Users
Employer/payer groups7,100
Medicare10,537
Medicaid21,359
Total195,129
Revenues
First-half 1997$178,875,844
1996$254,121,824Operational date: June 1994.
Federally qualified.
Licensed in: New Jersey.
Model type: IPA.
For profit.
Service area: New Jersey.
Services: General medical, dental, prescription drug, mental health. May be customized to meet employer specifications.
Rating options: Adjusted community rating.
Offers self-insured products.
Point-of-service contracts: 50% of members are enrolled.
Non-federally qualified programs.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: Roger Birnbaum, president/CEO; Marc Stein, CFO; Donald Parisi, general counsel; Dr. Joseph Singer, chief medical officer.
FOCUS Healthcare Management Inc.
7101 Executive Center Drive, Suite 375, Brentwood, Tenn. 37207; 800-873-0055 or 615-377-9936; fax: 615-661-4042
Specialty: workers compensation
Staff/Facilities*
Primary practitioners 3,137
Specialists 14,486
Hospitals70
Total Users3,980,902
Operational date: June 1989.
Service area: Connecticut: Hartford and New London counties; New Jersey: 20 counties; New York: New York and Richmond counties; Pennsylvania: Bucks, Chester, Jefferson and Philadelphia counties.
**Includes leased providers/facilities.
See FOCUS Healthcare Management Inc. consolidated listing under Tennessee.