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The Division of Workers’ Compensation has posted an example of a medical provider network (MPN) Application/Plan for Reapproval to help MPN applicants comply with SB 863’s statutory requirements and recent changes to MPN regulations that became effective August 27.

The DWC is no longer accepting paper submissions. When filing an MPN Application or Plan for Reapproval, MPN applicants shall submit two non-password-protected or unencrypted compact discs or flash drives in word-searchable PDF format that includes:

1. A completed section 9767.4 Cover Page for Medical Provider Network Application or Plan for Reapproval with an original signature (e-signatures are acceptable); and
2. A completed MPN Plan. Using the example described in this Newsline is advised. It can be found on the DWC website in the “Example Medical Provider Network (MPN) Application/Plan for Reapproval.”

Please be aware that per Labor Code section 4616, any MPN that was approved prior to January 1, 2011 and has not been reapproved by January 1, 2015 will expire and will not be able to accept new claims. Additionally, the DWC will not accept an MPN Application or Plan for Reapproval that fails to follow the requirements set forth in the California Code of Regulations, Title 8, Section 9767.3.