CNA sent a California provider a treatment authorization letter that may double as a setup for nonpayment.

The letter purports to authorize care while simultaneously warning that payment may be denied if the provider isn't in CNA's Medical Provider Network (MPN), a network for which the letter provides no name, MPN ID number, or web address. The provider is apparently left to figure it out alone.

California providers need to be on high alert for similar "authorizations," which may set a provider up for a potential reimbursement battle if the insurer denies payment for “authorized” services by claiming “provider not in network.”

This is, unfortunately, not unprecedented.

Payers sometimes issue documents that appear to be authorizations, but create a pretext for payment denial based on MPN non-participation. Injured workers and the providers trying to treat them often have no reliable way to determine which MPN applies to a given claim, whether a given provider is a member, or how to find out either.

As “provider not in network” payment denials continue, providers who treat without MPN verification, even when treatment is supposedly “authorized,” risk nonpayment. Unfortunately, determining an injured worker’s MPN and whether the provider is a member  is yet another administrative burden that providers must shoulder.

MPNs were meant to restrict injured workers to certain providers to ensure access to care and cost control. CNA shows how payers can use MPNs as a mechanism to deny payment for authorized treatment.

The MPN Setup

CNA sent a letter granting a physician "limited authorization for the evaluation and treatment" of an injured worker. However, the letter also states that CNA has issued "no waiver" of its MPN, and that the authorization "does not concede entitlement to treatment outside the MPN."

Translation: treat this patient, and CNA may deny your bill if you're not a member of its MPN.

One major problem: the letter contains no information whatsoever about which MPN applies to the injured worker. There’s no MPN name or ID number, or any web address for a provider roster. There is only a warning that an unspecified MPN applies.

The provider is expected to determine, on their own, which of California's thousands of MPNs governs this claim, a task the state's own MPN management system makes functionally impossible.

CNA's letter grants a veneer of authorization with one hand while planting the seed for a payment dispute with the other.

The Provider’s Burden

Before a physician can treat an injured worker for whom care is already “authorized,” the provider’s administrative staff needs to first contact CNA directly and request the following in writing:

1. The name of the MPN governing the injured worker's claim
2. The MPN ID number
3. The website address for the MPN's provider roster

Only then can the provider go to that roster, search for their name, and take a screenshot to document their MPN membership (evidence they may need if CNA later denies payment). The provider also has to trust that CNA’s online provider rosters are up to date; the state requires employers and insurers to update their rosters only four times per year.

Read that again. Before treating an injured worker, a provider must reach out to the insurer, locate a roster that may or may not be accessible or up to date, verify their MPN membership, and preserve evidence as protection against a denial that the authorization letter exists to prevent. All of this must happen before the provider has seen the patient even once for a visit that has already been “authorized.”

This is the level of absurdity California providers face every day, and one of several reasons injured workers struggle to access care.

When treating a patient requires this much administrative detective work before the first appointment, many providers simply avoid workers' comp altogether. Providers who haven’t yet learned the hard way will treat, bill, and get denied, because a seemingly conditional “authorization” is worthless.

The Broader Problem

This letter is a symptom of a system in which providers are routinely expected to navigate a barely-regulated maze of thousands of MPNs, each maintained by a different payer, each with its own provider rosters, updated as infrequently as four times a year, with no reliable centralized lookup tool and no requirement that any of it appear in an authorization letter.

While payers maintain the right to deny reimbursement based on MPN non-membership, providers often have no way to penetrate the tangled, opaque cluster of literally thousands of MPNs to verify their status. Accurate, current MPN information is a necessity to ensure payment, but it’s often impossible to find, or entirely nonexistent.

Until the California Division of Workers’ Compensation (CA DWC) requires payers to identify the applicable MPN in every authorization document and provide a direct path to verify membership, letters like this will continue to effectively function as reimbursement denial traps rather than permission to deliver necessary care.

Providers receiving this type of letter should not treat it as a guarantee of payment. Contact CNA, get the MPN information in writing, do the verification work, document every step, and be prepared to fight a denial that defeats the entire purpose of authorization.

That this is a common experience and not an outlier is the clearest evidence that MPNs don't just complicate billing. They impede injured workers’ care and drive providers out of the system, while authorizations that authorize nothing continue to create needless administrative friction.

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