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What is a medical provider network (MPN)?

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A Medical Provider Network (MPN) enables employers to provide medical treatment to injured employees through a network of physicians and medical groups.  The networks are set up by an insurer or self-insured employer and approved by the administrative director with the Division of Workers’ Compensation (DWC).   Each MPN must include a mix of doctors specializing in work-related injuries and with expertise in the general areas of medicine. 

The providers in the MPNs are required to follow all medical treatment guidelines established by the DWC and all injured employees a choice of provider(s) in the network after their first visit.  The MPN regulations require them to offer a second and third opinion if the injured employee disagrees with the diagnosis or treatment offered by the treating physician.  If a disagreement remains after the second and third opinion, an injured employee may request an independent medical review (IMR).

The MPN must have adequate physicians who treat common injuries experienced by injured employee based on the type of occupation or industry in which the employee is engaged.  The regulations requires at least three available physicians of each specialty.  It is not enough to have three physicians listed on the MPN; the physicians must be available to treat injured employees. 

The MPN must have at least three available primary treating physician and a hospital for emergency health, or a provider of emergency health services, within 30 minutes or 15 miles of each injured employee’s residence or workplace.  The MPN must have providers of occupational health services and specialists who can treat the common injuries within 60 minutes or 30 miles of each injured employee’s residence or work place.  The access standards for specialists are less restrictive, but still must maintain three available physicians within the specialty. 

Of course, each injury is unique and involves different treatment needs. If you have questions about the MPN or treatment for your workers’ compensation injury and want to talk with an attorney in Fresno, please call 559-408-7436 or fill out the form to the right.