Medical Providers Network (MPN)
For Workers' Compensation ClaimsPLEASE NOTE: Our Medical Providers Network (MPN) took effect November 1, 2008.
As the district’s MPN, WellComp has primary treating providers (facilities) conveniently available within 15 miles or 30 minutes; and specialty care treating providers within 30 miles or 60 minutes from your work or residence.
WellComp is the nationally managed-care company, whose network of medical providers has been approved by the state of California as the district’s MPN. The WellComp Medical Provider Network only involves injuries and illnesses that occur on the job. The MPN does not affect district offered health-plan benefits (non-workers’ compensation). Below is a summary of the MPN and your responsibilities if you have a work-related injury or illness.
WellComp Provider Directory
Access a directory of medical providers in the WellComp Network, where you can search by medical specialty, zip code, physician or provider group. To receive a hard copy of the regional area listing or complete WellComp directory, please contact WellComp.
If You Have a Work-Related Injury or Illness
In an emergency, go to the nearest emergency medical center and immediately advise your supervisor. For non-emergency situations, report the claim to your supervisor and, if necessary, seek treatment with one of the medical providers listed on the approved Clinics and Hospitals list posted at your site, or with your pre-designated physician. If you have difficulty in getting an appointment, or need any assistance in locating a provider, contact York Risk Services Group (York) at (866) 548-2701.
Although it is not required, you may pre-designate your physician prior to a work-related injury or illness. Labor Code section 4600(d)(2) provides that for purposes of establishing a pre-designated physician, a “personal physician” must be the employee’s regular physician and surgeon. Additionally, in accordance with Chapter 5 of Division 2 of the Business and Professions Code, chiropractors and acupuncturists may not be considered pre-designated treating physicians.
To pre-designate a physician, complete the voluntary Pre-Designation of Physician Form available in English and Spanish. Submit the completed form to the Risk Management Department if:
1) you have received care with the physician, and
2) the physician agrees to be your primary treating physician.
Your physician’s signature on the form will validate his/her willingness to participate in the MPN. If your physician does not agree to participate in this capacity, you will be required to seek care with a provider within the MPN.
Obtaining Authorization Prior to Treatment
Your treating physician must obtain prior authorization for services by calling York. York will review your physician’s treatment plan and render a recommendation. Your adjuster and physician will receive a copy of the review recommendation.
Appeal Language for Non-Certifications
If your treatment is not approved, you may request an appeal by following the appeal instructions that were attached to the non-certification notice.
Provider Changes or Requests for a Second or Third Opinion
You may change physicians within the MPN at any time, as long as the provider is appropriate to treat your injury. In the event you dispute the diagnosis or treatment prescribed by your treating physician, you may request another opinion. Under the MPN, you may request up to two additional opinions from other MPN physicians.
For instructions to proceed with the second and third opinion process, or to file a dispute you must contact York. York will provide you with a list of MPN physicians appropriate to your injury. If you dispute the third physician’s opinion, you may contact the California Department of Workers’ Compensation at (415) 703-4600 for an independent medical review.
Terminated MPN Providers and Continuity of Care
If your physician terminates from the MPN, York will advise you on your options for continued treatment as approved under the MPN Applicant’s Continuity of Care Plan. In some instances the terminated physician may continue to treat you through the district’s Continuity of Care plan. Copies of the plan are available upon request. Contact your York adjuster for questions or advice on your options.
Additional Information Regarding the Medical Provider Network (MPN)
For any questions relating to the MPN, Compensability, Benefits, Continuity of Care Plan, Transfer of Care Plans, please contact the MPN Liasion.
If you have further questions, please contact York RIsk Services Group, Inc.