SB 863 Changes to Labor Code 4616 Regarding Medical Provider Network (MPN)

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SB 863 Changes to Labor Code 4616 Regarding Medical Provider Network (MPN)

Senate Bill 863 made changes to rules surrounding Medical Provider Networks (MPN).  I just want to point out a few changes that will affect most providers.  The Labor Code is changed to say that starting on January 1, 2014 a treating physician shall be included in the network only if, at the time of entering into or renewing an agreement by which the physician would be in the network, the physician’s office provides a separate written acknowledgment in which the physician affirmatively elects to be a member of the network.  Therefore, it is extremely important for physicians to be on the lookout for letters from MPN’s soliciting this acknowledgment.  Read them and sign them and send them in.

 

SB 863 Changes

I believe that this new rule was imposed due to the fact that so many Medical Provider Networks included physicians that were no longer practicing or did not accept workers’ compensation patients.  It is puzzling to me that new the rule did not specifically indicate that the physician needed to acknowledge that they would accept workers’ compensation cases.  It is my experience that many of the existing MPN’s are multidimensional.  In other words they are not workers’ compensation specific.  Doctors joined PPO’s (Preferred Provider Networks)  in order to get referrals from many insurance sources.  I believe some MPN’s were established by just calling the PPO and MPN.  We have spent many hours calling up to 70 psychiatrists on MPN lists to find that not one of them accepts workers compensation cases.

 

Another part of the new rule is that Medical Provider Network’s will be required to post a roster on the internet of all treating physicians in the MPN.  While many MPN’s already provide internet searchable lists, some are secured and only allow access to the list with a user name and password which is only provided to adjusters and defense attorneys.

 

The last rule change I want to highlight is that MPN’s will be required to have Medical Access Assistants to help an injured employee find available physicians.  They have to have a toll free number and they have to be available at least from 7:00 a.m. to 8:00 p.m. Monday through Saturday.

 

 

By |2019-03-31T23:35:53-07:00October 24th, 2013|Medical Billing, Reporting|0 Comments

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