Medical Provider Network

Blue Cross of California / Kaiser On The Job

MPN OVERVIEW

Effective 1/1/05, California Senate Bill 899 (SB899) allowed the establishment of an employer Medical Provider Network (MPN). The MPN system requires, with some exceptions, employees to receive all treatment related to a work related injury or illness within this network for the life of the claim. Berkshire Hathaway Homestate Companies - Workers Compensation Specialty Division, has implemented a MPN as a powerful tool in reducing workers compensation insurance costs.

WHAT IS THE BERKSHIRE HATHAWAY HOMESTATE COMPANIES (BHHC) MEDICAL PROVIDER NETWORK?

A Medical Provider Network (MPN) is a group of healthcare providers created by an insurer or self-insured employer and approved by the California Division of Workers' Compensation for the purpose of providing medical treatment for work related injuries or illnesses. Each MPN must include a mix of physicians sufficient to treat common occupational injuries, and the MPN must meet access-of-care standards specified by the State of California.

THE BHHC MPN

The BHHC network is comprised of selected Blue Cross of California physicians and facilities, and Kaiser On-The-Job locations.

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.

CAN EMPLOYEES CHANGE THEIR DOCTOR?

Yes. After the initial medical evaluation with the employer-designated MPN provider, injured employees may choose another primary treating physician (or any subsequent physician) from the BHHC network.

HOW DO EMPLOYEES MAKE AN APPOINTMENT WITH AN MPN DOCTOR?

See How To Locate A Front Line Provider (below). For additional assistance in locating a provider in your area, you may contact the examiner directly or call the MPN Help Desk at (888) 495-8949.

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.

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.

EMPLOYEE NOTIFICATION REQUIREMENTS

The State requires that all employees be immediately advised of their rights and responsibilities as it relates to the MPN in a process referred to as notification. This notification process requires that each employee be provided a pamphlet notifying them of the MPN, how to access medical treatment in the event of an injury, and the policies & procedures of the Medical Provider Network. This letter must be provided in English and Spanish. (Click here for the English version.) (Click here for the Spanish version.)  In addition, in order to document distribution of this information, the employer must complete and sign the BHHC MPN Employee Notification Affidavit.  This document serves as verification that all employees have received the Notification of Rights information. (Click here for the BHHC MPN Employee Notification Affidavit).

The following are examples of how this notification process can be completed:

• Immediately: Provide each employee with the Notification of Rights Pamphlet form in person, via U.S. mail or payroll stuffer. Send BHHC the signed MPN Employee Notification Affidavit specifying method of notice.
• Hold an all-employee meeting and hand out the Notification Pamphlet at the end of the meeting. Send BHHC the signed MPN Employee Notification Affidavit.
• Send the Notification Pamphlet to all employees via e-mail.. Copy the BHHC MPN Coordinator on the e-mail, and include a signed copy of the MPN Employee Notification Affidavit.
• Continue to notify all new hire employees of the MPN at the time of hire. We suggest that this information be included in the new hire notification packet.

The importance of completing this notification process cannot be overstated, as incomplete or undocumented notification may jeopardize the costs savings afforded by the MPN system.

HOW TO LOCATE A FRONT-LINE PROVIDER

Click here for the Blue Cross of California Provider Search.