• What is a Medical Provider Network (MPN)? In 2004, the legislature approved SB 899, which allows for the establishment of MPNs to treat work injuries and illnesses on or after January 1, 2005. A MPN is an entity or group of health care providers set up by an insurer or self-insured employer and approved by the Division of Workers' Compensation Administrative Director to treat injured workers. 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.  

• What is the name of Republic Indemnity's MPN? Republic Indemnity has developed two distinct medical provider networks:  

(1)   Republic Indemnity Medical Provider Network, accessing Prudent Buyer (Blue Cross of California) Health Care Organization (HCO).

(2)   Republic Indemnity Kaiser On-The-Job Medical Provider Network

Policyholders may select from either MPN based on personal preference, current group medical provider or convenience of facility.

• What is the advantage of using an MPN for medical treatment? The biggest advantage is that Republic Indemnity will have medical control for the life of the claim. This will allow us to manage the type and frequency of medical treatment more effectively than in the past. By applying evidence-based treatment standards (as defined by the Division of Workers' Compensation Administrative Director), coupled with the contracting of medical providers, treatment abuses will be minimized, costs reduced, and treatment outcomes improved.   In a number of claims, duration of temporary disability will be reduced along with residual permanent impairment.

• When will Republic Indemnity's MPN be approved? Both of Republic Indemnity's MPN's have been approved.

• What if the employer does not use the MPN? If medical treatment has been initiated with a non-MPN provider on a new claim, the employer should immediately contact their Republic Indemnity claims adjuster.

• Does using the MPN result in premium savings?   Republic Indemnity's 2005 premium rates are based on the assumption that each employer will use the MPN for all new claims.   In the long run, we expect the advantages of an MPN to lower medical costs and premiums for all employers who actively use them.

• Why did Republic Indemnity select Blue Cross for an MPN? In 2004, Republic Indemnity partnered with Blue Cross of California to offer our policyholders access to the Blue Cross of California Prudent Buyer Plan Network and Prudent Buyer Comp Providers, who are specially qualified to treat occupational injuries. They also had an approved HCO, plus Blue Cross of California provides a network of industrial medical clinics (Frontline Providers) located throughout California that understand workers' compensation regulations and the importance of early return-to-work.   These specialists work closely with both the Blue Cross Case Manager and the Republic Indemnity staff for optimum outcome.   To obtain the name of a provider in the Prudent Buyer Network, we encourage our employers to access:

http://www.bclhwcmcs.com/ProviderFinder.htm

With the passage of SB899 and the creation of MPNs, using the relationship with Blue Cross and building upon the Prudent Buyer Plan Network and Prudent Buyer Comp Provider was a natural!

• Why is  Republic Indemnity partnering with Kaiser On-The-Job?    Kaiser On-The-Job has been a pioneer in developing special occupational medicine providers for treating work-related injuries.   They expanded on their core group of employed physicians to bring into the MPN specialists in chiropractic, acupuncture, and other specialty treatments.   Kaiser MPN providers may be accessed through the following website:

http://www.talispoint.com/kaiser/rii

• If the employer offers a group health plan to the employees that is not Blue Cross or Kaiser On-The-Job, how does that affect the MPN? Occupational injuries will be treated by the Republic Indemnity Medical Provider Network, accessing Prudent Buyer (Blue Cross of California) HCO and/or the Republic Indemnity Kaiser On-The-Job MPN. Non-occupational illnesses and medical treatment will continue to be provided through applicable group health medical providers.

• Can an employee pre-designate a physician prior to an industrial injury? Our legal counsel believes yes, but only if the employer provides a non-occupational group health plan, and the physician (MD/DO) must be a member of the non-occupational group health plan. The law is unclear and we anticipate litigation will occur which will ultimately clarify how pre-designation will be interpreted.

• Will small employers use the MPN for their employees? The MPN applies to all employees regardless of the size of the employer.

• How do I find out if a provider is a member of the MPN? For a Blue Cross provider, call the Blue Cross of California Prudent Buyer Plan Network at their toll-free number (866-700-2168) or access their provider directory at http://www.bclhwcmcs.com/ProviderFinder.htm.    For a Kaiser MPN provider, you may call (888) KOJ-WORK or access the provider directory at http://www.talispoint.com/kaiser/rii.1

• What about employers using a local clinic that is not in the MPN? The composition of the MPN is not Republic Indemnity's responsibility.   Contracting issues rest solely between a medical provider, Blue Cross and Kaiser.   If the current industrial clinic or provider is not a Blue Cross member or part of Kaiser On-The-Job, the employer is required to locate/post and refer injured workers to an MPN clinic or provider.   If the local provider is interested in becoming a Blue Cross provider, they may call Blue Cross at 714-935-3041.   Kaiser limits its contracting with providers, and at this time it is unknown if they will accept any additions.

• What happens if an employee is injured?   The employer must immediately provide the injured worker a "Notification Of Rights Pamphlet," which explains the Medical Provider Network process and the Employee Claim Form, DWC-1.   The Notification of Rights pamphlet, provided in English and Spanish, is included in our Claims Kit, and additional copies may be ordered from Republic Indemnity by faxing the request to our Mail/Supply Department at (818) 382-1297.   At the time of a work injury, refer the covered employee to a Blue Cross MPN Provider or Kaiser On-The-Job Medical Provider and immediately report the claim to Republic Indemnity.   We have developed an easy-to-use input screen for California policyholders to complete and electronically transmit the claim report via the Internet at www.republicindemnity.com. As a secondary option, contact our Claims Department between the hours of 7:00 a.m. and 5:30 p.m., or call our after-hours/weekend call center at (888) 336-7569.

• If the injury requires emergency care? The injured worker should be referred to the nearest appropriate medical facility/provider regardless of their MPN status.

• An employee had an injury last year, will the employee be in the MPN? "Transfer of Care" and "Continuity of Treatment" are the two most controversial MPN issues. Republic Indemnity has decided to handle all of these cases on an individual basis. Depending on the circumstances of the individual, the employee may or may not be transferred to an MPN physician. We also anticipate much litigation over this issue.

• If the employee is transferred to a new physician in the MPN, what happens if he/she doesn't like the physician? The employee may transfer to another physician or seek the opinion of another physician in the MPN.

• What if an employee disputes the medical treatment provided in the MPN? Independent Medical Review is a process provided for in the MPN for employees who continue to dispute the diagnosis or the medical treatment they are receiving after obtaining a second or third opinion within the network. They may appeal to an Independent Medical Reviewer appointed by the Administrative Director, who will review their case and issue an opinion on the appropriateness of the treatment compared to the utilization guidelines.

• I have heard that the employer's insurance company is responsible for paying medical bills for new claims in which injury is being disputed. Who is responsible for any financial liability?   Under the new law, an insured employer's insurance company is responsible for adjusting/paying medical bills up to $10,000 or until the claim is accepted or denied. There may be certain exceptions when this would not apply, such as a dispute over employment status or coverage, and affirmative defenses such as intoxication, self-inflicted injury, suicide, initial physical aggressor, off-duty recreational duties, conviction of a felony, post-termination injury, horseplay, etc. This is why it is so important to immediately report any injury claim and refer the employee to an MPN provider since the "clock starts ticking" as soon as the employee files the Employee Claim Form, DWC-1.

• Whom do I call for further information? Republic Indemnity has expended considerable time and effort training our staff on MPNs. The employer's claims adjuster has the knowledge and the resources to help with questions, or you may contact the following Division Claims Specialists: