Medical Provider Networks
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Apr 14, 2023
Coventry Emails Expose PPO/MPN Mirage
A series of emails between a California doctor and Coventry expose the unvarnished truth about Preferred Provider Organizations (PPOs) and Medical Provider Networks (MPNs). <...
Apr 12, 2023
Marriott - Networks Pocket Doctors' Pay
Does the Marriott hotel chain know where the money really goes when it pays for its employees’ medical treatment?Self-insured and with its own in-house claims administ...
Mar 30, 2023
CA DWC Must Stop Pretending MPNs Work
A real friend tells the truth, even when it’s uncomfortable to hear. As advocates for a better workers’ comp system, we haven’t been shy about pointing out its shortco...
Nov 2, 2022
MPNs: How to Detect Dubious Payment Denials
In California workers’ comp, one of the biggest — but least talked about — challenges for providers is navigating the Medical Provider Network (MPN) system. MPNs were ...
Nov 2, 2022
Sedgwick Stiffs QME With False MPN Denial (Again)
It’s been said that insanity is best defined by doing the same thing repeatedly, but expecting different results. If that’s the case, Sedgwick Claims Management Services has ...
Nov 2, 2022
Employers Insurance: False MPN Payment Denial
California allows insurers and self-insured employers to establish Medical Provider Networks (MPNs) to direct injured workers’ care. While Employers Preferred Insurance Compa...
Nov 2, 2022
Gallagher Bassett: False MPN Denial
In yet another instance of a claims administrator improperly denying payment because the provider was (allegedly) not a member of the applicable Medical Provider Network (MPN...
Nov 2, 2022
AmTrust: False MPN Payment Denial
AmTrust North America, a Third-Party Administrator (TPA), offered a perfect example of what makes the Medical Provider Network (MPN) system so challenging for California work...
Oct 13, 2022
CA MPN List Updates Q4 2022
The California Division of Workers’ Comp (DWC) updated its list of Medical Provider Networks (MPNs). The DWC update:Added 2 new MPNsApproved 3 previously suspen...
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May 20, 2021
MPNs: The Jekyll and Hyde of Workers' Comp
We’ve argued that MPNs are mostly a drag on the workers’ compensation system. But as some employers demonstrate, they don’t have to be.When employers use MPNs to maint...
May 11, 2021
Anthem/SCIF: MPN Kickback Scheme?
Healthcare software firm CareCloud recently agreed to a $3.8 million settlement, in part to resolve allegations that it traded unlawful payments for referrals, in violation o...
Apr 27, 2021
California MPNs: Camouflage for Discounts and Denials
Medical Provider Networks (MPNs) are under fire — as they should be.Far too often, Calforina claims administrators (aka ‘payers’) use MPNs — and providers’ unfamiliari...