2014 MPN Participation Agreement FAQs

State Fund Medical Provider Network (MPN)
2014 MPN PARTICIPATION AGREEMENT
FREQUENTLY ASKED QUESTIONS
(FAQs)
1. What is the State Fund Medical Provider Network (MPN) Participation Agreement
(PA)?
It is an agreement requiring all active MPN providers’ compliance for continued
participation in the State Fund MPN. This agreement supersedes the State Fund MPN
General Provisions and Criteria (GPC), previously signed.
2. Why is State Fund enforcing the Participation Agreement?
The MPN PA reinforces our focus on improving treatment outcomes, and patient safety for
our covered injured employees through State Fund’s Utilization Review (UR), Return-toWork (RTW), and Stay-at-Work programs, and other policy documents.
3. Are all State Fund MPN providers subject to the MPN PA?
Yes. All active MPN providers are required to comply with the MPN PA for continued
participation in the State Fund MPN.
4. If I received the MPN PA in multiple locations, can I just complete, sign, and fax back
just one MPN PA Signature Form?
Yes. One completed and signed MPN PA Signature Form is valid for all current locations on
file with State Fund.
5. Can I e-mail the MPN PA Signature Form to the State Fund MPN Helpdesk or mail it
directly to State Fund?
No. By faxing the completed and signed MPN PA Signature Form to the fax number
indicated in the cover letter, State Fund can receive and track your response more quickly.
Unfortunately, the State Fund MPN Helpdesk is not set up to receive and track the MPN PA
Signature Forms. We truly appreciate your faxing the one-page document to the dedicated
fax number (888) 205-6065.
6. What if I am on vacation or medical leave, and will not be back by the date the
Signature Form is due?
Any MPN member physician who does not submit a completed and signed MPN PA
Signature Form will be sent a reminder letter before the physician record is terminated.
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State Fund Medical Provider Network (MPN)
2014 MPN PA FAQs (continued)
7. Does the MPN PA affect my reimbursements for services?
No. The MPN PA does not in any way affect the Official Medical Fee Schedule (OMFS) or
the Resource Based Relative Value Scale (RBRVS), or your contracted rates with your
Network Vendor.
8. We are a Medical Group with membership in the State Fund MPN. What
documentation is required?
There are two versions of the MPN PA – Individual Physician and Medical Group. For
Medical Groups which are in the State Fund MPN, the Medical Director as the physician
representative, will complete and sign the MPN PA Signature Form on behalf of all the
physicians in the Medical Group.
All other State Fund MPN providers shall complete, sign, and return the Individual MPN PA
Signature Form.
9. Why do I have to be willing to assume the role of Primary Treating Physician (PTP)
when I am a specialist?
Only if State Fund or the patient requests would you need to assume the PTP role. Should
the patient requests that you be his or her PTP, please contact the assigned Claims
Adjuster. The Claims Adjuster will verify whether your specialty is appropriate to treat the
injury or illness.
10. When contacted, why do I need to respond to State Fund, peer reviewers, employers,
or injured employees within two business days? What if I am busy, or on vacation?
The 2-business day response time was set to expedite patient care. We understand you
have a busy schedule and need to be away from the office at times. We trust that someone
in your office can monitor and triage your calls when you are away.
11. Why did you choose the Official Disability Guideline (ODG) for RTW guides?
ODG provides lost time guidelines utilizing actual experience data from federal government
databases, specifically OSHA Bureau of Labor Statistics and the CDC, National Center for
Health Statistics, as well as the National Health Interview Survey. In addition, separate data
is provided for whatever factors would affect disability duration. You can certainly refer to
ACOEM and MTUS as well.
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State Fund Medical Provider Network (MPN)
2014 MPN PA FAQs (continued)
12. What is the problem with compounded medications?
Generally, compounded medications do not go through the same FDA approval process that
is required for commercially available prescription drugs. Therefore, trials may or may not be
conducted to determine safety and efficacy. Such studies are not a legal requirement for
compounded medications (American Chronic Pain Association Consumer Guide, 2011
Edition, page 58). If you feel that your patient requires a compounded medication, it can be
ordered, but pre-approval through DWC Form RFA must be obtained first.
13. What if I need to combine injectable medications for my patient in the office or
emergency room?
The combining of medications for injections and as a part of emergency medical services is
excluded and does not require pre-authorization.
14. I have an occasional patient who cannot tolerate oral medications, and compound
topicals are effective. How can I continue to prescribe medications in the formulation
my patients can tolerate?
It is acceptable to have active prescription medication placed in a cream, but the active
prescription medication must be the only component billed.
15. I understand the ramifications of long-term opioid use. But what if I inherit a patient
already on long-term opiates, or if I have a patient who is on a low dose and
successfully working/functioning?
Should a physician find clinical necessity to prescribe opiates beyond 30 days (i.e.
successful pain control on low dose or existing long-term usage), he or she will need to seek
pre-approval. That request would follow the normal UR process, including peer review (as
appropriate) along with the availability of the appeal process, if needed. Should the
physician continue to prescribe opiates after upheld denials, and particularly if such
occurred on a repeated basis, the physician could be put on notice for lack of compliance
with the MPN PA and the consequence process followed.
16. I respect the UR process, but sometimes the peer reviewer is not of my specialty and
does not seem to understand cutting edge EBM for my specialty. How are you going
to address this?
We are committed to UR that is neutral, objective, consistent, and appropriate. We are
enhancing our processes to ensure this with advanced technology and appropriate specialty
participation.
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State Fund Medical Provider Network (MPN)
2014 MPN PA FAQs (continued)
17. What should I do if my situation or patient is unique and does not seem to fit within
the parameters drawn in the MPN PA?
Our highest priority is to deliver expedited, high quality care to our injured workers and to
partner with you to do so. When in doubt, or when you have questions, call us. We are
committed to working with you. We have been doing outreach to major provider groups for
several months, but we realize that we cannot contact everyone personally. Please reach
out to us when you have questions or concerns, by contacting the Claims Adjuster.
18. Who do we contact if we have questions on the MPN PA?
Questions or concerns can be directed to the MPN Helpdesk at (866) 436-0204, or by email
at [email protected].
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