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1997 DIRECTORY OF MANAGED CARE PROVIDERS

Posted On: Dec. 28, 1997 12:00 AM CST

Georgia
AMERICAID Georgia Inc.
230 Peachtree St. N.W., Suite 510, Atlanta, Ga. 30303; 404-658-5000;
fax: 404-681-4145
Staff/Facilities
Primary practitioners468
Board-certified17%
Specialists1.072
Hospitals17
Pharmacies543
Primary care locations936Operational date: January 1998.
Licensed in: Georgia.
Service area: Georgia: Clayton, Cobb, DeKalb, Fulton and Gwinnett counties.
Officers: Dr. Dwight Jones, president/CEO; Theodore M. Wille, COO; Kathleen K. Toth, vp-finance.
See Americaid Community Care consolidated listing under Virginia.
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 practitioners70
Hospitals22
Service area: Georgia: Bibb, Chatham, Clarke, Clayton, Cobb, Dougherty, Fannin, Fulton, Gwinnett, Houston, Muscogee, Pulaski, Richmond and Ware 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 practitioners1,900
Specialists6,110
Hospitals70
Users: Group Health
Single coverage21,126
Family coverage92,873
Employees & dependents234,734
Users: Workers Compensation
Single coverage6,385
Total Users241,119
Operational date: 1986.
Service area: Georgia: 143 counties.
See Beech Street Corp. consolidated listing under California.
BlueChoice Healthcare Plan/ BlueChoice Option
3350 Peachtree Road N.E., Atlanta, Ga. 30326; 404-842-8000; fax: 404-842-8498
Staff/Facilities
Primary practitioners1,114
Board-certified79%
Patients/practitioner286
Specialists3,079
Hospitals54
Pharmacies960
Users
Employer/payer groups3,684
Single coverage70,379
Family coverage79,184
Medicare1,959
Total320,353
Revenues
First-half 1997$181,621,750
1996$233,890,087Parent: Blue Cross & Blue Shield of Georgia.
Operational date: August 1985.
Licensed in: Georgia.
NCQA fully accredited.
Model type: IPA.
For profit.
Service area: Georgia: 66 counties.
Services: General medical, vision, prescription drug, mental health. Services available unbundled. May be customized to meet employer specifications.
Rating options: Community rating; community rating by class; adjusted community rating.
Offers self-insured products.
Point-of-service contracts: 28% of members are enrolled.
Enrollment options: Contracts with HCFA to enroll Medicare beneficiaries. Individual enrollment is allowed.
Officers: John A. Harris, president; Dr. Mark Kishel, medical director; Gordon Church, COO: Ray Colleran, senior vp-marketing; Monye Connolly, vp-provider relations.
Contact: R. Judson Elliott, vp-major national sales.
BlueChoice PPO
3350 Peachtree Road N.E., Atlanta, Ga. 30326; 404-842-8000; fax: 404-842-8498
Staff/Facilities
Primary practitioners2,706
Patients/practitioner117
Specialists7,001
Hospitals130
Pharmacies1,800
Users: Group Health
Employer/payer groups1,752
Single coverage77,825
Family coverage84,469
Employees & dependents317,264
Users: Workers Compensation
Employer/payer groupsNA*
Total Users317,264
Ownership: Blue Cross & Blue Shield of Georgia.
Operational date: October 1984.
For profit.
AAHC/URAC accreditation status: Health Network Standards.
Service area: Georgia: 122 counties.
Services: General medical, prescription drug, mental health. 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; charges flat fee per employee, by percent of savings.
UR: Standard procedures. UR provided by the PPO.
Officers: Richard D. Shirk, CEO; Rick Rivers, COO; Ray Colleran, vp-marketing; Dr. Mark Kishel, medical director; Monye Connolly, vp-provider relations.
Contact: R. Tudson Elliot, vp-major national accounts.
**Workers compensation services provided by affiliated network.
CCN
5251 Viewridge Court, San Diego, Calif. 92123; 800-247-2898; fax: 619-278-1262
Staff/Facilities
Primary practitioners2,083
Board-certified80.4%
Patients/practitioner25.4
Specialists4,686
Hospitals84
Users: Group Health
Employer/payer groups88
Employees & dependents54,500
Users: Workers Compensation
Employer/payer groups7
Total Users*54,500
Service area: Georgia: 128 counties.
Services: General medical, mental health, workers compensation, ancillary services.
**Does not include workers compensation users.
See CCN consolidated listing under California.
CCN Elect
5251 Viewridge Court, San Diego, Calif. 92123; 800-247-2898; fax: 619-278-1262
Staff/Facilities
Primary practitioners1,301
Board-certified82.4%
Patients/practitioner0.01
Specialists3,045
Hospitals84
Users
Employer/payer groups2
Employees & dependents18
Total18Operational date: June 1996.
Service area: Georgia: 127 counties.
See CCN Elect consolidated listing under California.
CNA Managed Care-Atlanta
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Primary practitioners770
Specialists2,109
Hospitals21
Primary care locations13Service area: Georgia: Atlanta.
See CNA Managed Care POS consolidated listing under Illinois.
CNA Managed Care-Atlanta
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners5,574
Hospitals33
Service area: Atlanta.
See CNA Managed Care PPO consolidated listing under Illinois.
CNA Managed Care-Southern Georgia
CNA Plaza, Chicago, Ill. 60685; 312-822-5000; fax: 312-822-1690
Staff/Facilities
Practitioners1,414
Hospitals21
Service area: Georgia: Southern Georgia.
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*1,853
Board-certified52.9%
Patients/practitioner24.8
Hospitals69
Service area: Georgia: 90 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 practitioners23
Service area: Georgia: statewide.
See ChiroSource Inc. consolidated listing under California.
CIGNA HealthCare
of Georgia Inc.-Atlanta
100 Peachtree St., Suite 700, Atlanta, Ga. 30303; 404-681-7000; 404-681-7043
Staff/Facilities
Primary practitioners817
Board-certified81.1%
Patients/practitioner268.3
Specialists1,233
Hospitals27
Pharmacies1,033
Users
Employer/payer groups1,076
Total219,266Operational date: January 1982.
Federally qualified.
Licensed in: Georgia.
NCQA one year accredited.
Model type: IPA.
Service area: Georgia: 33 counties.
Point-of-service contracts: 64.2% of members are enrolled.
Non-federally qualified programs.
Enrollment options: Individual enrollment is allowed.
Officers: Heyward R. Donigan, Healthplan president/general manager; David Mancuso, assistant vp-marketing; Dr. William A. Alexander, medical director; Adrienne Simpson, director-client services; Brian Fetherston, sales director/manager.
Contact: Allene Morris.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA Managed Care Network of Augusta
The Equitable Building, 100 Peachtree St., Suite 700, Atlanta, Ga. 30303; 404-681-7000; fax: 404-681-7043
Staff/Facilities
Primary practitioners112
Board-certified73.9%
Patients/practitioner48.9
Specialists311
Hospitals4
Pharmacies99
Users
Employer/payer groups57
Total5,487Operational date: January 1995.
Licensed in: Alabama, Georgia.
Model type: IPA.
Service area: Georgia: Columbia, Houston, Jefferson, McDuffie and Richmond counties; South Carolina: Aiken County.
Point-of-service contracts: 88.4% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: Heyward R. Donigan, Healthplan president; Dr. William A. Alexander, medical director; David Mancuso, assistant vp-marketing; Brian Fetherston, sales director/manager; Louis Amis, provider relations manager.
Contact: Allene Morris.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA Managed Care Network of Macon
The Equitable Building, 100 Peachtree St., Suite 700, Atlanta, Ga. 30303; 404-681-7000; 404-681-7043
Staff/Facilities
Primary practitioners27
Board-certified81.5%
Patients/practitioner52.7
Specialists63
Hospitals1
Pharmacies59
Users
Employer/payer groups56
Total1,424Operational date: January 1995.
Licensed in: Alabama, Georgia.
Model type: IPA.
Service area: Florida: Bibb, Houston, Jones, Laurens and Wilkinson counties.
Point-of-service contracts: 72% of members are enrolled.
Enrollment options: Individual enrollment is allowed.
Officers: Heyward R. Donigan, Health plan president; Dr. Wiiliam A. Alexander, medical director; David Mancuso, assistant vp-marketing; Brian Fetherston, sales director/manager; Adrienne Simpson, director-client services.
Contact: Allene Morris.
See CIGNA HealthCare HMO/POS consolidated listing under Connecticut.
CIGNA PPO-Atlanta
The Equitable Building, 100 Peachtree St., Suite 700, Atlanta, Ga. 30303; 404-681-7000; 404-681-7043
Staff/Facilities
Primary practitioners948
Board-certified78.7%
Patients/practitioner78.3
Specialists2,224
Hospitals50
Users: Group Health
Employer/payer groups587
Total Users74,293
Operational date: July 1988.
Service area: Georgia: 34 counties.
Officers: Heyward R. Donigan, executive director/general manager; Dr. William A. Alexander, medical director; Brian Fetherston, sales director/manager; Louis Amis, provider relations manager; Dr. Mary Caulfield, associate medical director.
Contact: Andrew Green, 860-726-3586.
See CIGNA HealthCare PPO consolidated listing under Connecticut.
CIGNA PPO-Augusta
The Equitable Building, 100 Peachtree St., Suite 700, Atlanta, Ga. 30303; 404-681-7000; fax: 404-681-7043
Staff/Facilities
Primary practitioners114
Board-certified74.1%
Patients/practitioner19
Specialists328
Hospitals5
Users: Group Health
Employer/payer groups84
Total Users2,171
Operational date: January 1995.
Service area: Georgia: Columbia, Houston, Jefferson, McDuffie and Richmond counties; South Carolina: Aiken and Edgefield counties.
Officers: Heyward R. Donigan, executive director/general manager; Dr. William A. Alexander, medical director; Brian Fetherston, sales director/manager; Louis Amis, provider relations manager, Dr. Mary Caulfield, associate medical director.
Contact: Andrew Green, 860-726-3586.
See CIGNA HealthCare PPO consolidated listing under Connecticut.
CIGNA PPO-Macon
The Equitable Building, 100 Peachtree St., Suite 700, Atlanta, Ga. 30303; 404-681-7000; fax: 404-681-7043
Staff/Facilities
Primary practitioners29
Board-certified75.9%
Patients/practitioner50
Specialists80
Hospitals2
Users: Group Health
Employer/payer groups60
Total Users1,452
Operational date: January 1995.
Service area: Florida: Bibb, Crawford, Houston, Jones, Laurens, Monroe and Wilkinson counties.
Officers: Heyward R. Donigan, executive director/general manager; Dr. William A. Alexander, medical director; Brian Fetherston, sales director/manager; Louis Amis, manager-provider relations, Dr. Mary Caulfield, associate medical director.
Contact: Andrew Green, 860-726-3586.
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 practitioners3,283
Board-certified84%
Specialists11,562*
Hospitals67
Service area: Georgia.
**Includes ancillary providers.
See CorVel Corp. consolidated listing under California.
Crawford Care Alliance
5620 Glenridge Drive, P.O. Box 5047, Atlanta, Ga. 30302; 404-256-0830; fax: 404-845-3155
Specialty: workers compensation
Service area: Contracts with HealthCare Compare Corp. for workers compensation nationwide, excluding Maine, Nebraska, Vermont and Wyoming. Also serves Puerto Rico.
Officers: Dennis Smith, CEO/chairman; Archie Meyers Jr., president; Steven Edmunds, vp.
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 practitioners1,007
Specialists3,975
Hospitals34
Total Users1,931,518
Operational date: June 1988.
Service area: Georgia: 120 counties.
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;
fax: 813-938-2880
Staff/Facilities
Primary practitioners2,705
Board-certified67%
Specialists7,086
Hospitals108
Pharmacies157
Users: Group Health
Employer/payer groups19
Single coverage19,000
Family coverage23,000
Employees & dependents61,000
Total Users61,000
Service area: Georgia: statewide.
See Guardian Resources consolidated listing under Florida.
HealthCare COMPARE Corp.
3200 Highland Ave., Downers Grove, Ill. 60515; 630-241-7900; fax: 630-241-7856
Staff/Facilities
Primary practitioners*1,962
Specialists3,287
Hospitals**65
Service area: Georgia: 135 counties.
**Includes some specialists.
***Includes specialty hospitals.
See HealthCare COMPARE Corp./The AFFORDABLE Medical Networks consolidated listing under Illinois.
HealthsourceProvident
1300 Parkwood Circle, Suite 400, Atlanta, Ga. 30339; 770-303-1900;
fax: 770-984-2108
Staff/Facilities
Primary practitioners1,526
Board-certified75%
Specialists3,699
Hospitals96
Pharmacies1,345
Total Users**314,990
Ownership: CIGNA HealthCare*.
Operational date: January 1986.
For profit.
AAHC/URAC accreditation status: Health Utilization Management Standards.
Service area: Georgia: 90 counties.
Services: General medical, mental health. Services available unbundled. May be customized to meet employer specifications. Individual enrollment is allowed.
Compensation: Negotiates hospital charges by per diem, discount off customary rates, DRGs; is compensated by insurers; charges flat fee per employee.
UR: Standard procedures excluding retrospective review and second surgical opinion. UR provided by the PPO.
Officers: James Pesnell, CEO; Dave Kemmerer, Jerry Wheeler, Ron Schenck, Tim Klopfenstein, vps.
Contact: Pam Conway, 423-755-3288.
**Healthsource Inc. was acquired by CIGNA HealthCare in June 1997.
***Includes enrollment for Georgia, North Carolina, South Carolina, Tennessee.
HealthStar Inc.
Four Concourse Parkway, Suite 215, Atlanta, Ga. 30328; 770-396-1009; fax: 770-396-7755
Staff/Facilities
Primary practitioners3,908
Specialists7,258
Hospitals119
Users: Group Health
Employees & dependents216,979
Users: Workers Compensation
Single coverage400,000
Total Users616,979
Operational date: February 1990.
Service area: Georgia: statewide.
See HealthStar Inc. consolidated listing under Illinois.
Kaiser Foundation Health Plan
of Georgia Inc.
3495 Piedmont Road, Building Nine, Atlanta, Ga. 30305; 404-364-7000; fax: 404-364-4794
Staff/Facilities
Primary practitioners270
Board-certified79%
Patients/practitioner879.5
Specialists1,143
Hospitals24
Pharmacies125
Primary care locations128
Users
Employer/payer groups722
Single coverage56,186
Family coverage55,778
Employees & dependents234,094
Medicare3,657
Total237,751
Revenues
First-half 1997$167,670,854
1996$322,630,031Operational date: October 1984.
Federally qualified.
Licensed in: Georgia.
NCQA fully accredited.
Model type: Group.
Service area: Georgia: Barrow, Bartow, Butts, Cherokee, Clayton, Cobb, Coweta, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Hall, Henry, Newton, Paulding, Rockdale, Spalding and Walton counties.
Services: General medical, dental, vision, prescription drug, mental health, durable medical equipment, hospitalization, lab, X-ray, preventive medicine, health education, substance abuse. Services available unbundled. May be customized to meet employer specifications.
Rating options: Prospective experience rating.
Offers self-insured products.
Point-of-service contracts: 9.1% of members are enrolled.
Non-federally qualified programs.
Officers: Christopher Binkley, president; Dr. Bruce Perry, medical director; Julie Fortin, division counsel; Herman Weil, vp-marketing/business development; David Smith, vp-network development.
Contact: Judy Waits, 404-364-7217.
See Kaiser Permanente consolidated listing under California.