CA Medical Provider Network (MPN) FAQs
Here you can find the most frequently asked questions regarding Medical Provider Networks (MPNs).
How do employees obtain a referral to a specialist?
If the primary treating physician determines that a specialist evaluation is necessary and the referral has been authorized by the claims examiner, the employee must select the required specialist from within the BHHC network. Of course, the employee may seek assistance in the selection of the specialist from the primary treating physician or claims examiner.
How do I find a doctor within the MPN?
For assistance in locating a provider in your area, you may contact the examiner directly or call the MPN Help Desk at (888) 495-8949.
When did the most recent regulatory changes go into effect, and what happens if I'm not in compliance?
The last regulatory changes went into effect October 8, 2010. Policyholders not incompliance with these regulations may be subject to a fine from the State of California of up to $7,000 per violation and forfeit the right to direct medical control of Workers Compensation claims.
What if the employee disagrees with their doctor’s diagnosis or treatment plan?
It is the responsibility of the injured employee to advise their claims examiner of a disagreement and request a second opinion evaluation within the MPN. If the employee disagrees with the second-opinion physician's findings, a third opinion evaluation within the MPN may be obtained. If the employee disagrees with the findings of the third-opinion physician, an Independent Medical Review (IMR) may be required from the Administrative Director of the Division of Workers Compensation.