California Medical Provider Network
for Workers Compensation

Overview of a medical provider network

An MPN is a network of providers that has been certified by the State of California Division of Workers Compensation to provide health care to injured workers. The MPN has been certified by the State, and The First Health Network providers are an integral part of the certified MPN. The FirstHealth Network has met specific access and health care delivery standards for providers in the MPN.

Cast & Crew, through its insurance carrier, uses FirstHealth, a national managed-care company, whose network has been approved by the state under your employers MPN. For any questions relating to the MPN, compensability, benefits, continuity of care plan or transfer of care plans, please contact your employer or local claim office. To report an injury, contact your employer.

Provider pre-designation

You may pre-designate your physician(s) prior to injury using the attached form if (1) you have received care with the physician and (2) the physician agrees to be your primary treating physician. If your physician does not agree to participate in this capacity, you will be required to seek care with an MPN provider.

Treatment for work-related injury or illness

In an emergency, go to the nearest emergency medical center and notify your supervisor as soon as possible. For non-emergency situations, you may use either your pre-designated physician or contact Cast & Crew to locate a provider. The MPN has primary treating providers available within 15 miles or 30 minutes or specialty care within 30 miles or 60 minutes from your work or residence. If you have difficulty in scheduling an appointment or need any assistance in locating a provider, contact Cast & Crew, claims professional or nurse case manager. Should you sustain an injury while traveling, go to the nearest occupational health clinic or emergency facility. Notify Cast & Crew as soon as you return from traveling in order to obtain a referral to an MPN provider. If you need a specialist, your primary treating physician, claims professional or nurse case manager can locate a provider within the FirstHealth MPN.

Existing workers compensation claims

If you have a pending claim, contact your clame handler. You may qualify to continue treatment with your current provider under your employers transfer of care plan if your condition is acute, serious or chronic, or if treatment is for remission, to prevent deterioration, a terminal illness or for a scheduled surgery or procedure that will occur within 180 days.

Obtaining prior authorization for treatment

Your treating physician must obtain prior authorization for services by contacting your local claims office. The designated claims office will review your physician's treatment plan and render a recommendation. You, your claims professional and physician will receive a copy of the review recommendation.

Appeal of non-certifications

If your treatment is non-certified, you may request an appeal by following the appeal instructions that were attached to the non-certification notice.

Provider change

You may change physicians within the MPN as long as the provider is qualified to treat your injury. Your claims professional, nurse case manager or Cast & Crew can provide MPN provider names. If you require additional services beyond the initial visit, you may use any provider, appropriate to your injury, within the MPN.

Second and third opinions

If you dispute the diagnosis or treatment prescribed by your treating physician, you may request two additional opinions from other MPN physicians. To file a dispute, you must submit the objection in writing to the insurance carrier within 20 days of receipt of the decision in dispute. Your employer will set up a medical evaluation with a mutually acceptable MPN physician. If you dispute the third physician s opinion, you may contact the California Department of Workers Compensation at 415-703-4600 for an independent medical review.

Terminated MPN providers and continuity of care

If your physician terminates from the MPN, your employer will advise you on your options for continued treatment as approved under your employer's continuity of care plan. In some instances, the terminated physician may continue to treat you through your employers continuity of care plan. Copies of it are available upon request. Contact Cast & Crew or your local claims office for questions or advice on your options.

If you have further questions, please contact:

Cast & Crew Workers' Compensation Department - (818) 848-6022