The available resources on California MPNs leave a lot to be desired. We identified five common problems faced by anyone trying to use these resources.
Frequently Asked Questions
Q: How can I tell which providers are in a given MPN?
A: DaisyBill’s 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.
Q: Can I tell when a specific MPN ceased to be operable?
A: In a word, no. The paltry resources available to the provider make it nearly impossible to definitively establish when an MPN was operable, or even whether a provider is or was included in that MPN. Our advice: Providers should be suspicious of EORs or RFAs denied as not in network.
Q: I received RFA authorization, but payment was denied due to not being in the MPN or the ‘Approved Network’. Is this allowed?
A: This is absolutely not allowed. Authorization guarantees payment.
Explanation
Per Labor Code 4616, when an employer or insurer chooses to use an MPN, the DWC administrative director must approve the MPN list of providers used by the employer or insurer. The DWC maintains a web page with two links navigating to two PDFs of DWC-approved MPNs set up by self-insured employers and insurers. One PDF is ordered by approval date; the other PDF by name of applicant. This system is not without its challenges – we’ve identified five common problems faced by anyone trying to use these documents.
- The DWC MPN list is a 194-page PDF. It’s not possible to search or sort this cumbersome document, making it extremely difficult to find information about a specific MPN.
- There’s a lot of missing or incomplete information. For example, the list is supposed to contain a valid website for each MPN. However, our analysis determined that 78% of the MPNs on the list – a whopping 1,809 MPNs in total – are missing a URL. It also contains over 1,000 MPNs that have lost their “approved” status and are therefore inoperable.
- The DWC provides the MPN approval date – but not the date that an MPN was revoked, terminated, or withdrawn. There is no way to prove when a specific MPN was operable, nor to verify whether a provider was included in an inoperable MPN.
- Many employers list multiple MPNs, causing further frustration and confusion for providers trying to access the list.
- When an employer uses an insurer to set up their MPN, the MPN applicant name is listed by the name of the insurer, not the name of the employer. So there are 76 different MPNs listed under “Ace American Insurance Company,” for example. It is impossible to determine which employer corresponds to which MPN.
DaisyBill developers solved the first of these problems by converting the DWC MPN list into a spreadsheet, which is available to the public. Unfortunately, we cannot solve for the lack of valid websites, lack of end dates, and confusion around multiple MPNs.
Additional Information
Article 2.3 of the California Labor Code, which contains the legislature’s laws governing MPNs
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.