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StateCert_StateCert_AE_800x504_111016
StateCert_StateCert_AE_800x504_111016
StateCert_StateCert_AE_800x504_111016

State-certified Networks

With certified networks in 17 states, our expertise ensures your needs are covered

 

Fully bundled or network only – it's your choice

Many states allow certified network programs designed to closely manage workers’ compensation injuries and costs. Our certified networks manage medical costs and return-to-work outcomes without compromising quality of care. In addition, Coventry monitors legislative and regulatory changes in these states to ensure continued compliance and identify opportunities for program enhancements and modifications.

 

Fully bundled or network only – it's your choice

Many states allow certified network programs designed to closely manage workers’ compensation injuries and costs. Our certified networks manage medical costs and return-to-work outcomes without compromising quality of care. In addition, Coventry monitors legislative and regulatory changes in these states to ensure continued compliance and identify opportunities for program enhancements and modifications.

 

Fully bundled or network only – it's your choice

Many states allow certified network programs designed to closely manage workers’ compensation injuries and costs. Our certified networks manage medical costs and return-to-work outcomes without compromising quality of care. In addition, Coventry monitors legislative and regulatory changes in these states to ensure continued compliance and identify opportunities for program enhancements and modifications.

 

State-specific Solutions

Fully bundled program

In our fully bundled programs, we can act as the certified entity or support your own certification by supplying all the services required under the MCO regulations. We provide fully bundled MCO services in California (MPN), Connecticut (MCP), Florida (MCA), Georgia (MCO), Illinois (PPP), Kentucky (MCP), New Jersey (MCO), New York (PPO), Oklahoma (CWMP), Texas (HCN), and West Virginia (MHCP).

Network-only program

In our network-only programs, we provide all appropriate network documentation to support your certification. We provide network-only MCO services in Arkansas (MCO), California (MPN), Connecticut (MCP), Florida (MCA), Georgia (MCO), Illinois (PPP), Kentucky (MCP), Massachusetts (PPA), New Jersey (MCO), Oklahoma (CWMP), South Dakota (CMP), Texas (HCN), and West Virginia (MHCP).

State-specific workers' comp information

Coventry understands the challenges the current workers’ comp environment and regulations present to our customers and that developing a comprehensive solution to contain health care and disability costs can be a complex undertaking.

Need more information?

We work with providers in the Coventry, First Health, FOCUS, and MetraComp networks in the applicable states. Clients should direct questions from network providers to 800.937.6824.

To learn more about how our certified networks function in each state, please visit the respective state section below.

Arkansas

Arkansas' Managed Care Organization is available in all counties, and the use of Telephonic Case Management and Utilization Review are mandatory. Our statewide Arkansas "MCO" is offered fully bundled or on a network only basis.

California

California's Medical Provider Network is available in all counties accept Alpine, and utilization of a state approved Utilization Review organization is required. Our California "MPN" is offered fully bundled or on a network only basis.

Connecticut

Connecticut's Managed Care Plan is available in all counties, and the use of Utilization Review is mandatory. Our statewide Connecticut "MCP" is offered fully bundled or on a network only basis.

Florida

Florida's Managed Care Arrangement is available in all counties, and Telephonic Case Management is required at the onset of the claim. Our statewide Florida "MCA" is offered fully bundled or on a network only basis.

Georgia

Georgia’s Managed Care Organization is available in all counties based on Geographic Services Areas (GSA), and requires catastrophic case management be performed by a state certified catastrophic case manager. Our statewide Georgia "MCO" is offered fully bundled or on a network only basis.

Illinois

Illinois Workers’ Comp Preferred Provider Program is certified in all counties in the state, and requires annual state reporting. Our statewide Illinois "PPP" is offered fully bundled or on a network only basis.

Kentucky

Kentucky’s Managed Health Care Service is available in all counties. The use of Utilization Review is mandatory, and the program includes recommended triggers. Our statewide Kentucky "MHCS" is offered fully bundled or on a network only basis.

Massachusetts

Massachusetts’ Preferred Provider Arrangement requires Utilization Review and Return-to-Work Programs, with state approval required. Our Massachusetts "PPA" is offered on a network only basis.

Montana

Montana’s Managed Care Organization includes full state certification. Utilization Review and Peer Review of cases are reported to the state on an annual basis. Our Montana "MCO" is offered on a network only basis.

Nebraska

Nebraska’s Managed Care Plan is available throughout the state. Our statewide Nebraska "MCP" is offered fully bundled or on a network only basis. 

New Jersey

New Jersey’s Managed Care Organization is available throughout the state, and includes early intervention, Utilization review, Disability, Return-to-Work, Telephonic Case Management, and  fraud detection. Our statewide New Jersey "MCO" is offered fully bundled or on a network only basis. 

New York

New York’s Certified Preferred Provider Organization “PPO” is licensed and branded as MetraComp Certified PPO.  The plan is available in 26 of the 62 counties, and there are plans to continue certification expansion. Outside of the Certified Program, New York offers a Recommendation of Care (ROC) program in the remaining counties. 

Ohio

OHIO’s Qualified Health Program is available throughout the state. Telephonic Case Management and Utilization review are included in the program. Our statewide Ohio "QHP" is offered fully bundled or on a network only basis. 

Oklahoma

Oklahoma’s Certified Work Place Medical Plan is available throughout the state, and Utilization Review is required. Our statewide Oklahoma "CWMP" is offered fully bundled or on a network only basis. 

South Dakota

South Dakota’s Case Management Program is available in all counties, and Telephone Case Management is required. Our statewide South Dakota "CMP" is offered fully bundled or on a network only basis.

Texas

Texas’ Health Care Network can only be accessed through a certified HCN. For Carriers and employers in the Texas Workers’ Compensation system participation in a certified HCN is the only way to take advantage of provider discounts. Utilization review is not required, but is recommended as part of the program. Our Texas "HCN" is offered fully bundled or on a network only basis.

West Virginia

West Virginia’s Health Care Plan is available throughout the full state. Use of a certified network in West Virginia is mandatory in order to take advantage of PPO discounts. Our statewide West Virginia "MHCP" is offered fully bundled or on a network only basis. 

 

National resources

The following links are provided as a resource for all or many states:

Official Disability Guidelines >

International Academy of Independent Medical Evaluators>
Formerly American Academy of Disability Evaluating Physicians

American College of Occupational and Environmental Medicine >

State-specific rules, laws, information, and events >
Provided by workerscompensation.com

 

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