Medical Provider Networks are notoriously difficult to understand. Especially in California. Even more so in workers’ comp. Let’s start with the basics.
Frequently Asked Questions
Q: What, exactly, is an MPN?
A: A Medical Provider Network, or MPN, is a list of providers established by the employer to restrict an injured employee’s choice of providers for the care guaranteed by Labor Code 4600. Read more here.
Q: How can I tell which providers are in a given MPN?
A: The Daisy Wizard includes an MPN Database, which 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 resources available to the provider make it impossible to definitively establish whether a provider is included in an MPN.
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
If an employer elects to use an MPN, an injured employee’s choice of providers for care is restricted to providers who appear on the MPN list.
California Labor Codes provide a full definition. Article 2 of the Labor Code contains medical and hospital treatment laws, and assigns the employer responsibility for paying for medical treatment when an employee is injured during the course of employment.
Per Labor Code 4600 an employer must pay for all treatment “reasonably required to cure or relieve the injured worker from the effects of his or her injury.” This Labor Code lists all of the medical treatment an employer is responsible for providing to an injured employee.
Article 2.3 contains the legislature’s laws governing MPNs, with Sections 4616 through 4616.7 establishing the MPN requirements.
Per Labor Code 4616, paragraph (a), an employer, insurer, and a third party network may establish “a medical provider network for the provision of medical treatment to injured employees.”
It’s important to remember that MPNs are optional – employers are not obligated to create one. If they do choose to create one, all MPN provider lists must adhere to the MPN requirements set out in these eight Sections of the Labor Code.
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
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.