Workers’ Compensation in California
Coventry Workers’ Comp Services (“Coventry”) understands the challenges that the current workers’ compensation environment and regulations present to our customers’ and that developing a comprehensive solution to contain workers’ compensation costs can be a complex undertaking. In 2004 after the state of California implemented Senate Bill 899, Coventry Worker’s Comp Services (“Coventry”) developed a certified Medical Provider Network which offers our customers a more selective network which is designed to control injury care and reduce costs.
A Medical Provider Network (MPN) is a managed care program, established by an employer or insurer in CA to control injury care, reduce lost-time costs, and improve total claim outcomes. Beginning January 1, 2005, insurers and employers could submit their MPN for approval by the Division of Workers' Compensation’s administrative director pursuant to the CA Administrative Rules, Article 3.5, Section 9767.
Under the Regulations, the injured worker will be directed to the MPN for the initial visit. If further treatment is required, the injured worker can select any provider from the MPN. These regulations cover both new and existing workers’ compensation cases. Using an MPN requires extensive communication with the injured worker to identify the processes and services available at both implementation and at the time of injury.
Participation in an MPN is voluntary; however, once a carrier or employer becomes certified, new cases will be directed into the MPN whenever possible. Existing cases may be considered for transfer into the MPN based on Transfer of Care provisions of the Regulations. A carrier or employer is the certified entity.
Coventry Workers’ Comp Services (CWCS) provides access to its network for those clients who wish to become a certified MPN. Coventry’s MPN Network offering includes participating providers in the First Health and FOCUS Networks and includes several options, including:
- Narrow network – Based on non-HCO (Coventry standard) or HCO-approved (First Health Primary) configurations. Coventry’s narrow network configurations have been prepared through analysis of medical billing data and feedback from clients, providers, case managers and other stakeholders positioned to make informed provider recommendations. These configurations are designed for the payor or employer who desires a tightly-managed program in a more controlled access, aggressively-channeled [program environment].
- Broad network – Based on non-HCO (Coventry PPO) or HCO-approved (First Health Select) configurations. Coventry’s broad network configurations include all providers who have contracted to provide workers’ compensation services to our customers and who have met our requirements for participation in the network.
- Custom – This network configuration allows customization for participating providers based on the discretion of the certified entity as long as “access” requirements are met. Coventry can assist with the network filing requirements to confirm the reports are in the required formats.
When filing for MPN certification, a customer who chooses an HCO-approved configuration is not required to file the provider listing with the application. Nonetheless, the non-HCO offering may best meet a customer’s needs, and Coventry has prepared the provider list in the state-required format so that there is no additional effort required by the customer who chooses this option.
To learn more about how workers’ compensation functions in California please click the link below for up-to-date information, including contact numbers and forms relating to workers’ compensation on the official state website.