In the world of workers comp, it has become necessary for medical providers to know how to tackle MPN-related objections. Providers involved in California’s workers’ compensation system often face complications following DWC protocols regarding MPN. Though MPN serves as the bridge between healthcare providers and insurance companies, since these networks are established by insurance companies (or self-insured employers), they have more obligations than medical professionals.
If you are new to Californias healthcare industry, MPN, or Medical Provider Network, consists of a group of healthcare providers that meet specific quality and compliance standards set by the DWC. While the medical provider checks patients accessibility before providing treatment, the insurance company is responsible for leading the patients through MPN-related guidelines.
The insurance company may contact patients who choose to go outside the network to encourage them to return. Encouraging patients to return to MPN necessitates action. Insurance companies recognize the importance of MPNs in effectively managing medical expenses, improving treatment results, and speeding up claims processing. MPNs also streamline and oversee the workers’ compensation system to minimize fraudulent activities and misuse, improving efficiency and effectiveness.
As medical provider representatives, we understand the importance of helping medical professionals engage with MPN-related dilemmas, whether they are network participants or not. For MPN-affiliated providers, being part of the network ensures a steady influx of patients through referrals, thanks to direct employer and insurance company channels. These providers benefit from streamlined administrative processes, having mastered the documentation, reporting, and authorization protocols unique to the MPN, expediting claims processing, and reducing treatment delays.
On the other hand, medical providers outside the MPN must be acutely aware of the legal and financial nuances of treating workers’ compensation cases, particularly the specific conditions permitting out-of-network care, so they can ensure they receive proper compensation and avoid claim disputes. Considering about 30% of the patients opt for medical providers outside MPN, leaving nothing to curiosity, let’s discuss the commonly used valid reason based on which medical professionals can treat a patient under DWC guidelines:
Along with these, there are also some less common but equally valid reasons for outside MPN treatment and medical care. These reasons can include inadequate treatment, distance and travel time, second and third opinions, MPN termination, and change of MPN provider
To wrap up MPN compliance, the most important aspect medical professionals need to know is how to tackle insurance objections during billing. In most cases, the administrator objects that since the claim was accepted, the injured worker must receive treatment within the network. As your provider is outside MPN, they are no longer obligated to pay for the services. In such cases, ask her if there was MPN compliance on their end first. Mention the reason based on which the services are valid.
Being a medical provider representative, MLM helps its clients keep up with the DWC updates and comply with MPN regulations. Our team takes care of all the negotiations, going back and forth, ensuring you receive a maximum payout, and keeping you up to date with the latest updates and regulations.
