California Medical Provider Network (MPN)

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The CNA California Medical Provider Network (MPN) is a Workers' Compensation program that is jointly delivered by CNA and Coventry Health Care (Coventry), a nationally recognized healthcare company that CNA partners with for Workers' Compensation medical and occupational services. The MPN will be delivered through Coventry's network of medical providers and facilities. This network has been built to provide injured employees with timely and quality medical care and is available to assist the injured worker in returning to his or her prior health.

For Employers

In order to provide injured employees with access to the MPN, employers must:

Checkmark Icon Direct all injured employees to a medical provider within the California MPN Website. This site will help locate network providers specializing in Workers Compensation with a strong focus on returning injured employees back to work.

Checkmark Icon Post the California State DWC-7 Form and a panel listing of MPN providers that are in the employees' area. Create a panel of medical providers via the California MPN Website (click “Provider Panel” tab) or email your request to PPOPanelRequest@cna.com.

If you choose to email your request, please include:

Name of insured.
Address of insured (including zip code).
List any specific physicians that should be included in the panel.
Contact person.
If the panel can be sent electronically, include an email address.
If the panel should be sent by hard copy, include mailing address.

Timeframe for Completing Panel Submissions:

Up to 10 panel requests will be provided within 24 to 48 hours of the request.
Between 10 and 40 panel requests will be provided within five business days of the request.
For more than 40 requests, the Operations team will provide an estimated time of completion.)

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The Employee Notification (Spanish version) should be given to an injured employee at the time of injury.

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Send a Change of MPN Notice (Spanish version) to all injured employees if there is a change in the MPN.

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Send all employees a MPN Cessation/Termination Notice (Spanish version) if the MPN is no longer being used.

Employees may also designate a treating physician prior to any injury, if certain criteria are met, and if the employee completes the Predesignation of Personal Physician form prior to an injury. If the employee wants to designate a Chiropractor or an Acupuncturist, the employee must complete the Notice of Personal Chiropractor or Personal Acupuncturist prior to an injury.

These documents may be downloaded and printed as needed. However, these materials are only for the use by CNA insureds and are not to be reprinted by others.

IMPORTANT NOTE

Regarding the initial implementation of the MPN, please be advised that the regulations governing the MPN require the employer to take the above actions. Failure to meet the requirements may result in your inability to utilize the MPN.

QUESTIONS?

Employer Frequently Asked Questions contains information you need to know as an employer about administering claims using the MPN.

RELATED EMPLOYER RESOURCES

Workers’ Compensation Claim Kit Where you will find everything you need on CNA’s Workers’ Compensation services and resources including an Employers and Employees Guide to Reporting an Injury.

California State DWC-1 Claim Form Provide this form to employees within one working day upon knowledge of any occupational injury or illness which results in lost time beyond the date of injury or in medical treatment beyond first aid.

California State 5020 Form - Employer's Report of Occupational Injury or Illness Employers are required to complete this form for every occupational injury or illness which results in lost time beyond the date of injury or illness.

CNA Accident Investigation Form Employer’s guide to recording accident data which may be shared with CNA upon claim reporting.

First Fill Prescription Program - Employer's Quick Reference Guide With this pharmacy benefit program specifically designed for workers' compensation, injured employees can fill their injury-related prescriptions at one of 70,000 nationwide pharmacies with no out-of-pocket expense. Use this reference guide to learn more.

First Fill Prescription Program for Work-Related Injuries – English Provide this form to the injured employee so they can utilize the First Fill program at more than 70,000 nationwide pharmacies.

First Fill Prescription Program for Work-Related Injuries – Spanish Provide this form to the injured employee so they can utilize the First Fill program at more than 70,000 nationwide pharmacies.

For Injured Employees

MPN CONTACT

Your MPN contact can answer questions on the MPN, address MPN complaints and provide you a copy of any MPN notifications or policies.

The contact for your MPN is:

Shari Grapes, WC Claim Manager
PO Box 8317 Chicago, IL 60680-8317
888-202-4964 | shari.grapes@cna.com

MEDICAL ACCESS ASSISTANT

The MPN's Medical Access Assistant will help you find available MPN physicians of your choice and can assist you with scheduling and confirming physician appointments. The Medical Access Assistant is available to assist you Monday to Saturday, 7 a.m.-8 p.m. PST, and schedule medical appointments during doctors' normal business hours. Assistance is available in English and in Spanish.

The contact information for the Medical Access Assistant is:

Toll-Free Telephone Number: 888-202-4964
Fax Number: 312-260-2101
CNACAMPN@cna.com

RELATED EMPLOYEE RESOURCES

Workers’ Compensation Claim Kit Here you will find everything you need on CNA’s Workers’ Compensation services and resources including an Employers + Employees Guide to Reporting an Injury.

First Fill Prescription Program for Work-Related Injuries – English Bring this form and your injury-related prescription to your network pharmacy so you can utilize the First Fill program at more than 70,000 nationwide pharmacies.

First Fill Prescription Program for Work-Related Injuries – Spanish Bring this form and your injury-related prescription to your network pharmacy so you can utilize the First Fill program at more than 70,000 nationwide pharmacies.

Workers' Compensation Employee Information Card Employee information card for employees to take with them to doctor's appointments.