Horizon Casualty Services Inc.: Results In Action 

How One New Jersey Workers’ Comp/Personal Injury Protection PPO Has Maintained Exceptionally Low Dispute Rates  

Managing disputes can be a time-consuming and expensive operation for workers’ compensation (WC) and automobile personal injury protection (PIP) insurers, but it doesn’t have to be. Horizon Casualty Services Inc. (HCS) is a New Jersey Department of Banking and Insurance-approved workers’ compensation managed care organization (WCMCO) with extensive experience in the state. In the past, HCS has consistently maintained an exceptionally low dispute rate for its clients, and it continues to do so in 2024. 

The Benefits of Keeping It Local 

There are many benefits to keeping your preferred provider organization (PPO) local and having your PPO work for you. New Jersey is HCS turf and it has the home field advantage. The doctors in its PPO network are colleagues, friends, neighbors and family, and they work in the local communities. Having that trust built into these relationships and daily interactions only helps to foster a productive and trusting environment. Jackie Alonso, president of HCS, has repeatedly stated that “strong collaborative relationships are the key to success for workers’ compensation and auto insurers aiming to keep provider appeal, claim petition and PIP arbitration rates low.” 

Key Tips for Handling Disputes 

Three HCS tips for maintaining provider appeals rates well under 1% in WC and PIP continue to ring true today. The following tips maintain low dispute rates: 

• Cultivate strong provider relationships 
• Select a WC PPO with an outstanding reputation for provider data precision 
• Resolve provider bill payment inquiries proactively and in a timely way 

Strong Provider Relationships 

Backed by the strength and stability of Horizon Blue Cross Blue Shield of New Jersey (Horizon), HCS has cultivated relationships with the provider community that plays a role in managing how it handles disputes. HCS works closely with its providers to understand their concerns, address any issues, then use that information to learn. 

HCS has grown its provider relationships under the leadership of Maura Berger, HCS manager of clinical quality. Berger leads a team of nurses and provider relations representatives who actively collaborate to bring together ample clinical experience combined with the administrative experience of HCS’s network providers. “By combining clinical knowledge with administrative provider support, we have elevated our providers’ experience at HCS,” said Berger.  

Heidi Coluni, HCS director of provider networks, added that “providers have indicated that they appreciate the ways in which HCS operates much differently than other WCMCOs by maximizing the time spent together and addressing all concerns at once.” 

Pushing Things a Step Further 

Coluni works closely with her team to ensure that not only are the above “tips” put into action, they’re pushed one step further. She stated that “the folks managing disputes are the real heroes keeping our dispute rates low. We have seasoned professionals who understand the business as well as the providers.”  

The HCS Network team works closely together, sharing information and holding open forums about the types of disputes received. In 2023, HCS brought in a new manager, Dean Sterling, to oversee its disputes teams. Under Sterling’s leadership and guidance, team members were able to see past their individual work and look at the bigger picture and began to truly question why the dispute occurred from the start. This work has helped HCS to sustain its impressively low rate of disputes, a proactive approach that allows its teams to understand the types of disputes received and work hand in hand with providers — both to resolve them and to eliminate future issues.  

Alonso has cheered for her team and is proud to share its 2023 results, which demonstrate that strong relationships, precise data and the proactive management of provider inquiries will consistently lead to lower dispute rates. 

The Proof is in the Results 

In 2023, HCS had an overall appeals rate of 0.38% across its WC and PIP PPO network. HCS achieved a WC claim petition rate of 0.14% and PIP arbitration rate of 0.36%. 

With its strong relationships, HCS works with providers to meet them where it matters most. While its three tips offer valuable insight, the extensive work invested in minimizing dispute rates relies heavily on the dedicated individuals who manage the process on a daily basis. “The team’s knowledge and the way everyone works together is truly our advantage, and something that our clients both appreciate and have come to expect in New Jersey,” stated Coluni. 

To learn more about HCS and its approach, contact Jed Hoban, HCS business development executive, at Jed_Hoban@HorizonBlue.com or visit https://www.horizonblue.com/horizoncasualty/service-offerings/workers-compensation. 

About HCS 

HCS, an affiliate of Horizon, in business since 1994, is a leading PPO in New Jersey WC and PIP. HCS has a 100% direct-contracted provider network that includes almost all New Jersey acute care hospitals. The network delivers significant overall savings and, with its deep focus on precision, an extremely low appeals rate. Its PPO results, combined with its Healthcare Value Strategy and Outcomes Focused Network, enable insurers to be the best at delivering quality medical care to claimants at the right cost — clearly a win-win for all. Horizon is an independent licensee of the Blue Cross and Blue Shield Association. 

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