1997 DIRECTORY OF MANAGED CARE PROVIDERS

Tennessee
Admar Med Network
1551 N. Tustin Ave., Suite 300, Santa Ana, Calif. 92705; 714-953-9600; fax: 714-953-6309
Staff/Facilities*
Primary practitioners1,296
Specialists2,627
Hospitals100
Users
Employees & dependents44,501
Operational date: September 1991.
Service area: Tennessee: 80 counties.
**Includes leased providers/facilities.
See Admar Med Network consolidated listing under California.
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 practitioners5
Hospitals5
Service area: Tennessee: Davidson, Hamilton, Knox and Shelby counties.
See AnciCare PPO consolidated listing under Florida.
The Apple Plan
600 Jefferson Ave., Memphis, Tenn. 38105; 901-544-2228; fax: 901-544-2222
Staff/Facilities
Primary practitioners409
Board-certified75%
Specialists909
Hospitals22
Pharmacies30,000*
Users
Total56,891Parent: Blue Cross & Blue Shield of Tennessee-Memphis.
Operational date: July 1980.
Federally qualified.
Licensed in: Tennessee.
NCQA fully accredited.
Model type: IPA.
Not for profit.
Service area: Tennessee: Fayette, Haywood, Lauderdale, Madison, Shelby and Tipton counties. Member of HMO Blue USA nationwide excluding Louisiana, Mississippi, New Hampshire, South Dakota, Vermont, West Virginia and Wyoming.
Services: General medical, dental, vision, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications.
Rating options: Adjusted community rating.
Offers self-insured products.
Non-federally qualified programs.
Officers: Gene Holcomb, president; Debrah Cannon, CFO; Bill Cecil, executive director; Dr. Frank Scott, medical director; Sid Peck, vp-sales/marketing.
**Estimate.
Blue Preferred
801 Pine St., Chattanooga, Tenn. 37402; 423-755-5600; fax: 423-763-3178
Staff/Facilities
Primary practitioners2,767
Board-certified67%
Specialists5,894
Hospitals137
Pharmacies1,571
Users: Group Health
Employees & dependents22,355
Total Users22,355
Ownership: Blue Cross & Blue Shield of Tennessee.
Operational date: November 1996.
Not for profit.
AAHC/URAC accreditation status: Health Network Standards.
Service area: Tennessee: statewide.
Services: General medical, vision, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem; is compensated by employers/payers; charges by premium rate.
UR: Standard procedures. UR provided by the PPO.
Officers: Tom Kinser, CEO; Gene Holcomb, president; Bill Everly, senior vp/CFO; Joan Harp, senior vp-sales/marketing; Dr. Steven Coulter, senior vp/chief medical officer.
CNA Managed Care-Memphis
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Primary practitioners254
Specialists703
Hospitals6
Primary care locations3Service area: Tennessee: Memphis.
See CNA Managed Care POS consolidated listing under Illinois.
CNA Managed Care-Knoxville
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners1,899
Hospitals21
Service area: Tennessee: Knoxville.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Memphis
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners1,536
Hospitals23
Service area: Tennessee: Memphis.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Nashville
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners3,066
Hospitals49
Service area: Tennessee: Nashville.
See CNA Managed Care PPO consolidated listing under Illinois.
CAPP CARE Inc.
West Tower, 4000 MacArthur Blvd., Suite 10000, Newport Beach, Calif. 92660; 800-937-2277; fax: 714-251-2222
Staff/Facilities
Primary practitioners*27
Board-certified78.2%
Hospitals2
Service area: Georgia: Dade County; Tennessee: Hamilton and Meigs counties.
**Includes specialists.
See CAPP CARE Inc. consolidated listing under California.
ChiroSource Inc.
P.O. Box 130, Clayton, Calif. 94517; 510-672-5333; fax: 510-672-6657
Specialty: chiropractic
Staff/Facilities
Primary practitioners11
Service area: Tennessee: statewide.
See ChiroSource Inc. consolidated listing under California.
CIGNA HealthCare of Tennessee Inc.-Memphis
6555 Quince Road, Suite 215, Memphis, Tenn. 38119; 901-755-7411; fax: 901-758-5121
Staff/Facilities
Primary practitioners276
Board-certified78.2%
Patients/practitioner330.5
Specialists759
Hospitals12
Pharmacies259
Users
Employer/payer groups471
Total91,235Operational date: January 1988.
Licensed in: Tennessee.
NCQA fully accredited.
Model type: IPA.
Service area: Arkansas: Crittenden County; Mississippi: DeSoto County: Tennessee: Fayette, Shelby and Tipton counties.
Point-of-service contracts: 52.2% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: David Mathis, general manager; Dr. David O. Hollis, medical director; Patrick Hoffman, sales director/market manager; Lisa Ellis, quality assurance manager; Chuck Utterback, provider relations manager.
Contact: Colleen Caughron.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA HealthCare of Tennessee Inc.-Nashville
1000 Corporate Center Drive, Suite 500, Franklin, Tenn. 37067; 615-595-3059; fax: 615-595-3590
Staff/Facilities
Primary practitioners387
Board-certified76.4%
Patients/practitioner160.3
Specialists820
Hospitals20
Pharmacies375
Users
Employer/payer groups321
Total62,063Operational date: January 1985.
Licensed in: Tennessee.
NCQA fully accredited.
Model type: IPA.
Service area: Tennessee: Cannon,
Cheatham, Coffee, Davidson, De Kalb, Dickson, Hickman, Maury, Montgomery, Robertson, Rutherford, Sumner, Williamson and Wilson counties.
Point-of-service contracts: 39.2% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: David Mathis, general manager;
Dr. Frederick Buckwold, medical director; Donna Keel, provider relations manager; Kathy Cartwright, quality assurance manager; Patrick Hoffman, sales director/market manager.
Contact: Joan Linkous.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA Managed Care Network-Chattanooga
1000 Corporate Central Drive, Suite 500, Franklin, Tenn. 37067; 615-595-3059; fax: 615-595-3590
Staff/Facilities
Primary practitioners153
Board-certified74.5%
Patients/practitioner38.4
Specialists283
Hospitals9
Pharmacies165
Users
Employer/payer groups61
Total5,885Operational date: April 1995.
Licensed in: Tennessee.
Model type: IPA.
Service area: Georgia: Catoosa, Dade, Walker and Whitfield counties; Tennessee: Bradley, Hamilton, Meigs and Sequatchie counties.
Point-of-service contracts: 70% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: David Mathis, general manager;
Dr. Frederick Buckwold, medical director; Patrick Hoffman, sales director/market manager; Donna Keel, provider relations manager; Kathy Cartwright, quality assurance manager.
Contact: Joan Linkous.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA Managed Care Network-Jackson
6555 Quince Road, Suite 215, Memphis, Tenn. 38119; 901-755-7411; fax: 901-758-5137
Staff/Facilities
Primary practitioners51
Board-certified70%
Patients/practitioner56.1
Specialists75
Hospitals18
Pharmacies147
Users
Employer/payer groups41
Total2,864Operational date: February 1991.
Licensed in: Tennessee.
Model type: IPA.
Service area: Tennessee: Benton, Carroll, Chester, Crockett, Gibson, Hardeman, Haywood, Henderson and Madison counties.
Point-of-service contracts: 54.4% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: David Mathis, general manager; Dr. David O. Hollis, medical director; Chuck Utterback, provider relations manager; Lisa Ellis, quality assurance manager; Marianne Kimble, UM health services manager.
Contact: Colleen Caughron.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA PPO-Chattanooga
1000 Corporate Central Drive, Suite 500, Franklin, Tenn. 37067; 615-595-3059; fax: 615-595-3590
Staff/Facilities
Primary practitioners152
Board-certified74.3%
Patients/practitioner36.3
Specialists285
Hospitals9
Users: Group Health
Employer/payer groups154
Total Users5,526
Operational date: January 1988.
Service area: Georgia: Catoosa, Dade, Walker and Whitfield counties; Tennessee: Bradley, Hamilton and Meigs counties.
Officers: David Mathis, health plan president; Dr. Frederick Buckwold, medical director; Patrick Hoffman, sales director/manager; Donna Keel, provider relations manager; Scott Mann, planning/analysis-medical economics.
Contact: Michael C. Kelly, 860-726-3794.
See CIGNA HealthCare PPO consolidated listing under Connecticut.
CIGNA PPO-Jackson
6555 Quince Road, Suite 215, Memphis, Tenn. 38119; 901-755-7411; fax: 901-758-5121
Staff/Facilities
Primary practitioners83
Board-certified66.1%
Patients/practitioner81.3
Specialists76
Hospitals15
Users: Group Health
Employer/payer groups72
Total Users6,754
Operational date: July 1996.
Service area: Tennessee: Benton, Carroll, Chester, Crockett, Dyer, Gibson, Hardeman, Haywood, Henderson, Lauderdale, Madison and McNairy counties.
Officers: David Mathis, health plan president; Dr. David O. Hollis, medical director; Chuck Utterback, provider relations manager.
Contact: Michael C. Kelly, 860-726-3794.
See CIGNA HealthCare PPO consolidated listing under Connecticut.
CIGNA PPO-Memphis
6555 Quince Road, Suite 215, Memphis, Tenn. 38119; 901-755-7411; fax: 901-758-5121
Staff/Facilities
Primary practitioners309
Board-certified77%
Patients/practitioner60.9
Specialists719
Hospitals12
Users: Group Health
Employer/payer groups250
Total Users18,825
Operational date: January 1988.
Service area: Arkansas: Crittenden County; Mississippi: De Soto County: Tennessee: Fayette, Shelby and Tipton counties.
Officers: David Mathis, health plan president; Dr. David O. Hollis, medical director; Patrick Hoffman, market manager;Chuck Utterback, provider relations manager.
Contact: Michael C. Kelly, 860-726-3794.
See CIGNA HealthCare PPO consolidated listing under Connecticut.
CIGNA PPO-Nashville
1000 Corporate Center Drive, Suite 500, Franklin, Tenn. 37067; 615-595-3059; fax: 615-595-3590
Staff/Facilities
Primary practitioners450
Board-certified77.4%
Patients/practitioner98.3
Specialists1,013
Hospitals25
Users: Group Health
Employer/payer groups287
Total Users44,270
Operational date: January 1985.
Service area: Tennessee: Bedford, Cannon, Cheatham, Coffee, Davidson, De Kalb, Dickson, Hickman, Maury, Montgomery, Robertson, Rutherford, Sumner, Williamson and Wilson counties.
Officers: David Mathis: health plan president; Dr. Frederick Buckwold, medical director; Patrick Hoffman, market manager/sales director; Donna Keel, provider relations manager; Scott Mann, planning/analysis-medical economics.
Contact: Kathleen Gillanders, 860-726-5784.
See CIGNA HealthCare PPO consolidated listing under Connecticut.
CorVel Corp.
1920 Main St., Suite 1090, Irvine, Calif. 92714; 714-851-1473; fax: 714-851-1469
Staff/Facilities
Primary practitioners977
Board-certified95%
Specialists4,878*
Hospitals74
Service area: Tennessee.
**Includes ancillary providers.
See CorVel Corp. consolidated listing under California.
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 practitioners43,367
Board-certified99%
Specialists159,464
Hospitals2,013
Total Users22,101,388
Ownership: Concentra Managed Care Inc.
Operational date: 1986.
For profit.
Service area: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin.
Services: General medical, dental, vision, prescription drug, mental health, workers compensation, chiropractic, long-term care. Services available unbundled. May be customized to meet employer specifications.
Compensation: Negotiates hospital charges by per diem, discount off customary rates, percent of fee schedule; is compensated by employers/payers, insurers; charges by percent of savings.
Officers: Thomas F. Cox, president; Dona-Marie Geoffrion, vp-product development/quality improvement.
Contact: Gina Grivich.
**Figures are consolidated, including all PPO plans in this organization. ***Includes leased providers/facilities.
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 practitioners1,393
Specialists3,261
Hospitals83
Total Users3,548,064
Operational date: February 1990.
Service area: Tennessee: 85 counties.
**Includes leased providers/facilities.
See FOCUS Healthcare Management Inc. consolidated listing under Tennessee.
Guardian Resources Inc.
2739 U.S. Highway 19 North, Suite 350, Holiday, Fla. 34691; 813-938-2222; 813-938-2880
Staff/Facilities
Primary practitioners2,009
Board-certified57%
Specialists3,529
Hospitals83
Pharmacies45
Users: Group Health
Employer/payer groups11
Single coverage2,000
Family coverage1,200
Employees & dependents4,640
Total Users4,640
Service area: Tennessee: statewide.
See Guardian Resources consolidated listing under Florida.