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Thread Title: MPN Physician Notice
Created On Monday June 30, 2008 2:59 PM

theAxe
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Monday June 30, 2008 2:59 PM

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Scenario:

1. Medical office applies and is accepted into the MPN with notification letter.
2. Years go by with physicians actively treating patients thru the MPN (and having bills adjusted to reflect the MPN discount)
3. Medical office starts receiving letters from defense attorney advising that as the facility is no longer on the approved MPN list they object to all bills for service relative to a named patient after facility was removed from the list.

Doesn't the IC/ER have to notify you of when and/or why your facility may be removed from their list??
The facility is still listed as approved on the MPN online listing.

What about continuity of treatment - the objection notice was not sent to the patient and the patient denies receiving any other information requiring them to change physicians.

Does the physician facility have any recourse here? What would be an appropriate response under these circumstances?

Where can I find MPN rules for these kinds of situations?
I've looked at the DIR website for MPN rules and seen what they have, but nothing seems to address this very basic situation.
Thanks for any information...

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theAxe

stewshe@comcast.net
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Monday June 30, 2008 7:00 PM

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theAxe,

You need to file a complaint with the Medical Unit. As I recall the person you need to send it to is Sandra Coleman. I have a sample complaint form which I passed out at the CAAA seminar last week....but now am vacationing in Pismo and the e-mail address eludes me. I printed it at the top of the form...with the UR complaint form on the other side.

I'd had a complaint about an MPN, requested a form and was told to send an e-mail to I believe Sandra Coleman. I did, requesting a form, and was told there wasn't one, but if I would answer the questions which followed, she would accept the complaint.

I did. She did, and my complaint got results.

Good luck!

Hopefully, someone will see this who has the e-mail address. Otherwise, I'll post it when I get back to Clovis in a few days.

-------------------------
Stew (James T. Stewart) e-mail: stewshe@comcast.net
Author: Work Comp Index & Tables & Schedules in "The Labor Code Book," by LexisNexis/Matthew Bender.

7th ed. Work Comp Index (912 pgs), $119.00 ea; next ed. summer, 2010 {Discounts for orders of 12 or more}
Send check or money order & shipping info. (I cannot take credit cards.)

Prices INCLUDE sales tax, and shipping.

James T. Stewart; 1937 Santa Ana; Clovis, CA 93611

stewshe@comcast.net
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Monday July 07, 2008 7:16 AM

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The e-mail address for Sandra Coleman regarding Medical Provider Network Complaints is:

scoleman@dir.ca.gov

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Stew (James T. Stewart) e-mail: stewshe@comcast.net
Author: Work Comp Index & Tables & Schedules in "The Labor Code Book," by LexisNexis/Matthew Bender.

7th ed. Work Comp Index (912 pgs), $119.00 ea; next ed. summer, 2010 {Discounts for orders of 12 or more}
Send check or money order & shipping info. (I cannot take credit cards.)

Prices INCLUDE sales tax, and shipping.

James T. Stewart; 1937 Santa Ana; Clovis, CA 93611

Edited: Monday July 07, 2008 at 7:17 AM by stewshe@comcast.net

theAxe
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Monday July 21, 2008 10:05 AM

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Thanks, Stew.

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theAxe

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