#006222 (VDN 2222200)
Paychex Business Solutions, LLC Page 1 of 5 CA Claim Packet –
revised 8/2017
California Medical Provider Network (MPN) and Employee
Information
Paychex and Gallagher Bassett have partnered to offer
policyholders the efficiencies of Medical Provider
Networks (MPN) for the benefit of the injured workers and their
employers.
Employers in conjunction with the insurance industry developed
the MPN program, which subsequently
received legislative approval aimed at providing injured workers
with the best medical treatment and an
early and safe return to productive lives. The MPN program is
offered at no additional cost to the
employers, but to be successful, it does require employer
cooperation by informing employees of their
rights and responsibilities under the MPN program.
The Full Written MPN Notification must be given to the injured
worker. The employee should sign the
acknowledgment letter; however, the MPN regulations are silent
about Employee Acknowledgement
Letters.
When the injury is reported or at the time of injury, the
injured worker must receive the Full Written
MPN Notification. Ctrl + Click on the following links to access
the English and Spanish versions.
• Full Written MPN Notification – English
• Full Written MPN Notification – Spanish
Employees reporting a claim are to be provided the Employee MPN
Information Notification Packet,
with a "Unique MPN Number" affixed to the document. This
document is specific to Gallagher Bassett:
MPN Name: Gallagher Bassett Platinum MPN
DWC MPN Identification Number - 2346
MPN Effective Date: 6/1/2015
MPN Address: 2850 Golf Road, Rolling Meadows, IL 60008-4050
A Medical Provider Network Medical Access Assistant is available
to help injured employees with finding
available MPN physicians and scheduling provider
appointments:
• Locate an MPN doctor by calling GBMCS at 1-855-203-2845.
• At the voice prompts, select Option 1.
Employers are to create a MPN Panel Card and post it at the
workplace. Please consider using your
Internet Browser to access www.talispoint.com/cvty/gbmpn and
create the Panel Cards that can be
posted at the workplace. Below is contact information:
Website for Paychex providers in the CA Medical Provider Network
(MPN):
• Visit www.talispoint.com/cvty/gbmpn
• Search for a provider or create a Work Site Poster (Batch
Tab)
https://gallagherbassett.app.box.com/s/w1q7um6bc7x3t27krsdqzwihm51uv83yhttps://gallagherbassett.app.box.com/s/w1q7um6bc7x3t27krsdqzwihm51uv83yhttps://gallagherbassett.app.box.com/s/owf8gvrjcymt3p2ly6vcrcdhityvla68https://gallagherbassett.app.box.com/s/owf8gvrjcymt3p2ly6vcrcdhityvla68http://www.talispoint.com/cvty/gbmpnhttp://www.talispoint.com/cvty/gbmpnhttp://www.talispoint.com/cvty/gbmpnhttp://www.talispoint.com/cvty/gbmpn
#006222 (VDN 2222200)
Paychex Business Solutions, LLC Page 2 of 5 CA Claim Packet –
revised 8/2017
To find medical providers use the Medical Access Assistant line
or use the following instructions access the online CorVel MPN:
Go to www.talispoint.com/cvty/gbmpn • Click "Address Search"
• Enter city, zip (State is default – CA)
• Networks: GBMCS MPN (Default)
• Search Distance (1,2,5,10,15,20,25,30,35,50,75,100 miles)
• Sort Results by (Distance, Name, Specialty, MMI)
• Providers per Page (10, 15,20,25,50,100,500)
• Select Provider Type / Specialty: "Occupational / Industrial
Clinics" and click FIND
PROVIDERS
(This will show you a list of medical clinics in the area that
are participating within
the MPN program)
Poster and Employee Notification:
The DWC-7 is required to be posted at the workplace. Both
English and Spanish versions are required to
be posted.
Please review the requirements for the Time of Hire Pamphlet
Distribution Requirements under
California Labor Code 3551:
• Time of Hire Pamphlet – English
• Time of Hire Pamphlet – Spanish
The New Hire Pamphlet is to be provided to each new employee at
the time of hire. This includes facts
about the MPN, Workers' Compensation facts, Pre-Designation of
Personal Physician and Notice of
Personal Chiropractor/Acupuncturist as well as information about
notices that must be provided to
employees about workers' compensation benefits.
The Workers' Compensation Claim Form (DWC-1) along with the
Notice of Potential Eligibility should be
completed with each employee at the time of injury. The DWC-1
and signed acknowledgment should be
provided when reporting a claim.
To obtain the electronic version of the Employee Packet for easy
downloading and printing, visit Paychex
online at:
http://download.paychex.com/pas_pbs/pbsform1.html:
• Scroll down to the Worker's Compensation section
• Click on "Injury Reporting Packet"
At Paychex Business Solutions, we believe timely reporting is
the best approach in minimizing claim
exposure, staying proactive, and ultimately helping your
employees receive appropriate medical care at
the time of injury. Participation in the MPN will help support
medical cost containment and facilitate
prompt return to work. If you have any questions about the MPN
program, please contact your Paychex
HRG and/or Safety representative before implementation so that
you will be informed and in
compliance. If you have questions, please contact Gallagher
Bassett at 866-855-0230.
http://www.talispoint.com/cvty/gbmpnhttp://www.talispoint.com/cvty/gbmpnhttps://gallagherbassett.app.box.com/s/a0x8ol802r0ngt7ql9p0vprhdgsyzkwlhttps://gallagherbassett.app.box.com/s/a0x8ol802r0ngt7ql9p0vprhdgsyzkwlhttps://gallagherbassett.app.box.com/s/lnpk35es1zl3rjyoc8131a43kqtbjcyxhttps://gallagherbassett.app.box.com/s/lnpk35es1zl3rjyoc8131a43kqtbjcyxhttps://gallagherbassett.app.box.com/s/4kjmk42sy570v834x7xewn14aq6toy19https://gallagherbassett.app.box.com/s/4kjmk42sy570v834x7xewn14aq6toy19http://download.paychex.com/pas_pbs/pbsform1.htmlhttp://download.paychex.com/pas_pbs/pbsform1.html
