SEDGWICK PROVIDER NETWORK RULES for CA
Provider Selection
Medical Provider Network: Unless the employee has predesignated (see below), the employer controls medical direction for the initial visit. Thereafter, the employee may change treating physicians, but only within the Medical Provider Network (MPN). Selection of a treating physician shall be based on the physician's specialty or recognized expertise in treating the injured worker's injury or condition.

Predesignation: If the employer provides nonoccupational group health coverage in a health care service plan or provides nonoccupational health coverage in a group health plan or health insurance policy the employee may notify his or her employer in writing prior to the date of injury that he/she wishes to be treated by his/her primary care physician who: has previously directed his/her medical treatment, retains the employee's medical records including medical history, and agrees to be predesignated.

Provider Lists/Panels
Medical Provider Network: Provider postings are permitted, and the employee may request access to the complete MPN. Access is available at this web-site, or by contacting the employer or at Sedgwick at 1-800-625-6588.

Managed Care Options
California Senate Bill 899 allows for the provision of a Medical Provider Network plan, and in addition to a medical provider network, the MPN plan allows for a process for second and third opinions, transfer of ongoing care, continuity of care, and independent medical review.



Utilization Management and Review
Utilization Review for medical services can be conducted for pre-authorization, concurrent review, and retrospective review. Utilization Review treatment guidelines follow the treatment guidelines of the Medical Treatment Utilization Schedule (MTUS). Chiropractic, occupational therapy, and physical therapy visits are capped at 24 visits each.

Additional Regulation
The employee can be held financially responsible for unauthorized care.