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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)

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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.

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Creating a MPN Panel Card

Use your Internet Browser to access www.talispoint.com/cvty/gbmpn

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