1. DWC

Medical provider networks

A medical provider network (MPN) is an entity or group of health care providers set up by an insurer or self-insured employer and approved by DWC's administrative director to treat workers injured on the job. Under state regulations, each MPN must include a mix of doctors specializing in work-related injuries and doctors with expertise in general areas of medicine. MPNs are required to meet access to care standards for common occupational injuries and work-related illnesses. The regulations also require MPNs to follow all medical treatment guidelines established by the DWC and allow employees a choice of provider(s) in the network after their first visit. Additionally, MPNs must offer an opportunity for second and third opinions if the injured worker disagrees with the diagnosis or treatment offered by the treating physician. If a disagreement still exists after the second and third opinion, an injured worker in the MPN may request an MPN independent medical review (MPN IMR). The MPN program became effective Jan. 1, 2005 and employees can be covered by an MPN once a plan has been approved by the DWC administrative director.

Who has an MPN?

• Searchable lists of approved medical provider networks are now available on the Department of Industrial Relations’  Open Data Portal at CA.gov
  • Active Medical Provider Networks with expiration date
  • Current list of approved medical provider networks by approval date
  • Current list of approved medical provider networks by name of applicant
    

MPN rules

• California Code of Regulations, Title 8 sections 9767.1 - 9767.19

MPN forms

• Disclosure of contract reimbursement rate
• Cover Page for Medical Provider Network Application or Plan for Reapproval
• Notice of medical provider network plan modification section 9767.8
• Independent medical review application
  (for injured workers who need to get an independent medical review - MPN)
  
• Solicitud de Revisión Médica Independiente

Medical provider network forms

MPN notices

• End of Medical Provider Network (MPN) Coverage Notice – (No Effect on Medical Treatment)

MPN resources

• Link for Physicians, Practitioners or Providers Suspended Pursuant to LC 139.21 (a)(1)
• Example Medical Provider Network Application/Plan for Reapproval
• Frequently asked questions about medical provider networks
• Memo to health care providers interested in joining an MPN

August 2023