MPNs are more important than ever after the landmark reforms of Senate Bill 1160. Learn how knowing your MPN status can help you file a lien.
Frequently Asked Questions
Q: Does a provider need to be part of an employer’s Medical Provider Network (MPN) to file a lien?
A: Only if the employer elects to use an MPN. See below for more details.
Q: How can I tell which providers are in a given MPN, and therefore able to file a lien?
A: Our searchable MPN database provides links to the MPN website, when available. Using that link, you can manually check whether a specific provider is listed as part of an MPN. But in general, there is a shocking absence of verifiable information concerning MPNs. In many cases, the paltry resources available to the provider make it impossible to definitively establish whether a provider is included in an MPN. Our advice: Providers should be suspicious of EORs or RFAs denied as not in network.
Q: Wait. What even is an MPN?
A: We have an article for that. Check it out!
Explanation
Senate Bill 1160 contains landmark reforms that affect the entire California workers’ comp community. One of its most significant amendments comes to Labor Code 4903.05, requiring lien claimants to file a lien declaration. This reform takes effect in 2017, and impacts both new and existing liens.
Under the reforms, lien claimants must satisfy at least one of seven new requirements. Of the seven, two concern Medical Provider Networks (MPNs). From Labor Code 4903.05, subsections (c) (1), (A) through (G):
For liens filed on or after January 1, 2017, any lien claim for expenses under subdivision (b) of Section 4903 that is subject to a filing fee under this section shall be accompanied at the time of filing by a declaration stating, under penalty of perjury, that the dispute is not subject to an independent bill review and independent medical review under Sections 4603.6 and 4610.5, respectively, that the lien claimant satisfies one of the following:
a. Is the employee’s treating physician providing care through a medical provider network
b. Is the agreed medical evaluator or qualified medical evaluator.
c. Has provided treatment authorized by the employer or claims administrator under Section 4610.
d. Has made a diligent search and determined that the employer does not have a medical provider network in place.
e. Has documentation that medical treatment has been neglected or unreasonably refused to the employee as provided by Section 4600.
f. Can show that the expense was incurred for an emergency medical condition, as defined by subdivision (b) of Section 1317.1 of the Health and Safety Code.
g. Is a certified interpreter rendering services during a medical-legal examination, a copy service providing medical-legal services, or has an expense allowed as a lien under rules adopted by the administrative director.
When an employer chooses to use an MPN, all treating physicians included in the MPN may file a lien to recover unpaid charges.
When an employer elects not to use an MPN, any treating physician may file a lien to recover unpaid charges.
Knowing the employer’s choice of MPN may allow providers to qualify as a lien claimant.
Additional Information
Article 2.3 of the California Labor Code, which contains the legislature’s laws governing MPNs
Full Text of Senate Bill 1160
DaisyBill Resources
Blog Post: Introducing Our Searchable MPN Spreadsheet
Webinar: Understanding Medical Provider Networks
DaisyBill Solutions
DaisyWizard Searchable MPN Database
DaisyBill’s Revenue Cycle Management software features a built-in MPN selection tool that allows you to quickly attach an approved MPN to a specific patient injury and verify which providers are in the MPN.
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