Certified Managed Care Plans

A medical provider network (MPN) is a network of providers, including physicians, created to provide medical treatment for work injuries of employees in California. Self-insured employers or workers' compensation insurers may have an MPN. Under SB 863, an entity providing physician network services can also have an MPN. An MPN must be approved by the California Division of Workers' Compensation (DWC) before it can be used. Unless exempted by law or the employer, all medical care for workers injured on the job whose employer has an approved MPN will be handled and provided through the MPN.

Under state regulations, each MPN must:

  • a mix of doctors specializing in work-related injuries and doctors with expertise in general areas of medicine
  • are required to meet access to care standards for common occupational injuries and work-related illnesses
  • follow all medical treatment guidelines established by the DWC 
  • allow employees a choice of provider(s) in the network after their first visit.
  • must offer an opportunity for second and third opinions if the injured worker disagrees with the diagnosis or treatment offered by the treating physician. If a disagreement still exists after the second and third opinion, an injured worker in the MPN may request an independent medical review (IMR).

Resources

California MPN FAQ-SB 863 Changes

State of California DWC 7 Form - Notice to Employees

Continuity and Transfer of Care Policies

Provider Profiling Methodology

Predesignation of Personal Physician

Chiropractor Predesignation

DWC MPN Complaint Form

MPN Second and Third Opinion Process

Independent Medical Review Application

Modification of Medical Provider Network Plan

SB 863 Employee Notification Requirements

End of Medical Provider Network (MPN) Coverage Notice

 

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