Essential topics and tips linking workers compensation and your policy. 2009 Issue 2 In This Issue: State Fund Medical Provider Network: Quality Care and Cost Control Express Scripts: Fast Pharmacy Solutions MEDfinder MPN Search: Find a Network Physician Quickly and Easily Our MPN Begins With You: 5 Things to Know and Do The MPN Quiz! Test Your Knowledge Channeling to an MPN Physician: A Win-Win for Employees and Employers Our Medical Providers Understand Your Needs State Fund Medical Provider Network
State Fund Medical Provider Network: Quality Care and Cost Control At State Fund, we understand how disruptive a workplace injury can be to your injured employee s life and your business. As a State Fund policyholder, you have our promise of high-quality medical treatment and dedicated claims management whenever one of your employees experiences an on-the-job injury or illness. There is a way you can help us achieve the best possible results in restoring your injured employee to health and productivity: Always make use of the State Fund Medical Provider Network (MPN). We ve set up this comprehensive statewide network of doctors and medical facilities for treating workers compensation injuries. When you direct your injured employee to receive care through our MPN, you can drive a number of positive outcomes: Effective treatment for your injured employee. State Fund MPN providers have expertise in occupational health and workers compensation insurance, and patients under their care often return to work sooner. Cost efficiency and containment. When medical treatment happens within our MPN, State Fund can maintain medical control for the life of the claim. This supervision enables us to control costs, which ultimately helps keep your rates down. In fact, the creation of medical provider networks was a key element of California s 2004 workers compensation reform legislation. Efficient case management. Our claims personnel coordinate appropriate medical care STATE FUND through our Utilization Review Program. Because of enhanced communication between State Fund, MPN physicians, and employers like you, there is an R integrated team approach to returning your injured employees to work as soon as medically reasonable. More Choices for You and Your Employees The State Fund MPN provides access to a wide range of providers throughout California, including: Approved medical facilities close to home or work. Physicians who primarily treat occupational injuries. Hospitals and emergency facilities accessible 24/7. After receiving initial treatment from an MPN primary physician, your injured employee may choose a different MPN provider for ongoing treatment. The MPN also allows your injured employee to obtain referrals for specialist services when appropriate. As long as MPN physicians provide the care, you still reap the cost-saving benefits. For additional information on State Fund s MPN, contact your regional office, or visit www.scif.com and choose MEDfinder MPN Search under Quick Links.
Our MPN Begins With You: 5 Things You Need to Know and Do As an employer, you hold the keys to unlocking the full potential of the State Fund MPN. Even if you are not accustomed to having workplace injuries, it is a good idea to be aware of your responsibilities for upholding the MPN at your jobsites. Let s take a look at five required actions that all employers must take: Provide and Post Notices 1. Provide the New Employee s Guide to Workers Compensation brochure (form 13286) to all your new employees when you hire them. 2. Provide the Employee s Guide to the State Fund MPN brochure (form 13176): To all your employees, 30 days before you implement the MPN in your workplace. To new employees at the time you hire them. To any employee who reports a work-related injury or illness. 3. Post the Notice to Employees posting notice (form 13708) conspicuously in the work area. If you have Spanish-speaking employees, you must also post the notice in Spanish (form 13709). The posting notice provides vital workers compensation and medical treatment information for your employees. It also has a space for you to write in MPN contact information for your workplace (doctor, hospital, and ambulance). Be sure to choose an MPN doctor or medical provider facility and write this information on your posting notice. If you do not post this notice, your employees may be allowed to choose their personal physician for treatment, and State Fund may lose medical control of the claim. Ensure Treatment Within 3 Days With a State Fund MPN Provider 4. When you learn of a work-related injury or illness, ensure that your injured employee receives medical treatment from a State Fund MPN provider within 3 business days. In an emergency, however, you may refer your injured employee to any nearby medical service provider or hospital. 5. Report an injury promptly to State Fund s Claims Reporting Center. We recommend reporting within 24 hours after you learn of a workplace injury or illness. Cost-Saving Opportunities and Claims Control Being proactive and taking these mandated actions before any workplace injury or illness will set you up to benefit from the State Fund MPN: State Fund maintains medical control of the claim, which can reduce claims costs, and your injured workers get care targeted toward returning them to work as soon as possible. If you need any required brochure or posting notice, call our Customer Service Center at (888) 222-3211. Be Proactive Report the Injury
The The MPN Quiz! Test Your Knowledge A Fun Quiz to Better Understand State Fund s MPN Program True or false? Your employees may not predesignate a personal physician for use in the event of a workplace injury or illness. FALSE: Your employees may predesignate a personal physician if you provide them with group health coverage (HMO/PPO/HCO) and they meet certain other conditions. To predesignate, your employees must submit the predesignation form (found in the New Employee s Guide to Workers Compensation brochure) before an injury occurs. True or false? Your injured employee can change physicians within the State Fund Medical Provider Network. TRUE: After an MPN doctor s initial evaluation, your injured employee has the right to choose another primary treating physician or subsequent physician from the MPN. True or false? You are not required to notify your employees of how to obtain medical treatment if an injury occurs during the course of employment because they can access MPN information at www.scif.com on their own. FALSE: The law requires you to post the Notice to Employees posting notice in a conspicuous location frequented by your employees. If your staff includes MPN FYI: Contact Us The State Fund team is here for you when you need us: State Fund MPN Help Desk: For MPN questions or an MPN provider listing, call (866) 436-0204 or e-mail scifmpn@scif.com. Customer Service Center: To order MPN brochures or to get immediate medical referrals, call (888) 222-3211. State Fund Web site: To find an MPN care provider or links to more MPN information and resources, visit www.scif.com and select MEDfinder MPN Search under Quicklinks. 24-hour Claims Reporting Center: To report a workplace injury or illness, call (888) 222-3211. Spanish-speaking employees, you must also post the Spanish version of the posting notice. You should write the name and telephone number of your MPN provider on the posting notice. If you don t properly post this notice, your employees may seek treatment from their personal physician. True or false? As an employer, you may wait until a workplace injury has occurred to notify the employee about workers compensation and how to obtain medical treatment. FALSE: When you hire employees, you must notify them of their workers compensation rights and how they can obtain medical treatment. You can easily fulfill this responsibility by giving each newly hired employee a copy of the New Employee s Guide to Workers Compensation and the Employee s Guide to the State Fund MPN. Our Medical Providers Understand Your Needs State Fund actively educates and updates our MPN providers about the workers compensation system. That s one reason our MPN physicians are so effective in treating your employee and controlling claims costs. They know workers compensation and the importance of getting your employees back to work. Specialists on Your Side To support our MPN physicians, State Fund draws on the expertise of specialists who help make sure that medical treatment is effective and appropriate. Our own staff of statewide medical community liaisons (MCLs) use their distinctive skills to facilitate communication among State Fund, treating physicians, and employers like you. Contracted health consultants such as doctors, nurses, and physical therapists help review medical information and treatment requests and communicate directly with the treating physician. Your uniquely qualified MPN physicians, supported by the State Fund team, can achieve valuable results for all: Your employees experience better outcomes, and you realize the cost savings of a well-managed claim.
Channeling to an MPN Physician: A Win-Win for Employees and Employers If your employees are hurt on the job, one of the best things you can do for them and yourself is to get them to a physician in our Medical Provider Network (MPN). Directing your injured employee to an MPN physician is a win-win: Employees win because the MPN features physicians specially trained to treat workplace injuries and help employees return to work as quickly as possible. Employees often experience better medical outcomes when using an MPN physician. Employers win because using the State Fund MPN helps contain the cost of the claim, keeping your rates down. That is why it s important for you to choose an MPN physician and write the physician s contact information on the legally required notice that you post in your workplace. To search for an MPN physician, visit www.scif.com and under Quick Links, choose MEDfinder MPN Search. Maintain Medical Control Establishing medical control is a key component in achieving a positive outcome on a claim. You can play a significant role in this process by immediately channeling your injured employees to MPN physicians. When an injured employee notifies you of a work-related injury, you should ensure that a network physician performs an initial medical evaluation within three business days. If an MPN physician does not see your injured employee within that three-day period, the employee may seek treatment by a non-mpn physician. If that happens, we lose medical control of the claim and the ability to contain costs. Report the Injury Too As important as it is to channel your injured employees to the MPN, you also need to remember to report any workplace injury to State Fund s Claims Reporting Center at (888) 222-3211. We recommend reporting the injury within 24 hours, although the law allows you up to five days from the time you find out about the injury. Timely reporting is in everyone s interest. The sooner you report the claim, the sooner we can advise you and your injured employee on proper courses of action, including coordinating treatment through the State Fund MPN. MEDfinder MPN Search: Find a Network Physician Fast! The State Fund MPN includes doctors, hospitals, and other medical providers located throughout California. Whether you need the name of an MPN provider or you are helping an employee find treatment, we ve made it easy for you to get the right information. State Fund s MEDfinder MPN Search is an online search tool that helps you quickly find physicians and facilities. MEDfinder MPN Search is easily accessible and completely customizable for your needs. To get started, go to www.scif.com and choose MEDfinder MPN Search from the Quick Links menu. On the welcome page, select Start your search now and you will come to the main search page. Here you can create a custom list of MPN providers using such criteria as: The location of your workplace, a jobsite, or a home address. Types of providers (initial treatment, primary treatment, and specialists). Services such as urgent care, hospitals, pharmacies, and skilled nursing facilities. MEDfinder MPN Search offers helpful details on each provider. State Fund updates the MEDfinder MPN Search provider database every month, so you know you re getting current information on quality care providers.
California State Employees Assn. Express Scripts: Fast Pharmacy Solutions Prescription medications are often a key to helping your injured employee get better and get back to work. But prescription medications can often be very expensive, and similar drugs can carry vastly different costs. State Fund has a solution for you and your employees. Our pharmacy benefit management program, Express Scripts, helps control costs while ensuring that your injured employees get the medication they need for recovery. Express Scripts improves both efficiency and medical outcomes through such measures as drug utilization review, formulary management, and drug data analysis services. For employees, Express Scripts offers conveniences that include free home delivery of medications, an extensive network of retail pharmacies (more than 95 percent of California pharmacies participate), and 24-hour access to network pharmacists. From authorization to billing, the program performs nearly every step electronically, which saves your employee time and saves you money. State Fund 2009 Issue 2 State Compensation Insurance Fund 1275 Market Street San Francisco, CA 94103 Address Service Requested Published by State Compensation Insurance Fund www.scif.com 2009 State Compensation Insurance Fund UNION LABEL State Printing Trades Unit 14