California Medical Provider Network

California Medical Provider Network
EMPLOYER IMPLEMENTATION CHECKLIST
This information is for EMPLOYER USE ONLY and should not be distributed to employees
Helmsman Management Services strongly encourages the use of the Liberty Mutual Group Medical
Provider Network (MPN) in California, as it provides one of the most effective ways to control workers
compensation costs.
This checklist is designed to assist customers implementing the MPN.
You must complete the following MPN implementation requirements:
1. Update the CA Notice to Employees – Injuries Caused by Work form DWC 7* (or update the MPN section of
your currently posted DWC 7). This form is required to be posted at every CA employer location. The following
information should be entered when you implement the Liberty Mutual Group MPN:
–– Current MPN toll-free number: 844-208-1659
–– MPN website: helmsmantpa.com/providernetworks
–– MPN effective date: Enter the date the MPN was implemented (DWC 7 form)
–– Current MPN address: 175 Berkeley St., Boston, MA 02116-5066
*The DWC 7 form can be found on the CA Division of Industrial Relations website.
(http://www.dir.ca.gov/dwc/forms.html under Legacy forms)
2. Confirm that your organization has implemented the Liberty Mutual Group MPN:
Option 1:Respond to the introductory email you receive from Helmsman Management Services, OR
Option 2:Send an email to [email protected] and include the following information:
–– Company name
–– Workers compensation account number
–– Your name, title, and contact information
–– The date your MPN program implementation was completed
WHEN AN OCCUPATIONAL INJURY OR ILLNESS IS REPORTED:
Employer:
■■
■■
■■
In an emergency, call 911 or seek immediate medical care as appropriate.
For nonemergency injuries, direct the employee to an MPN provider. To identify a medical provider in your area, you or the injured
worker may:
–– Access Provider Referral Services (PRS) at www.libertymutualprs.com, or
–– Call 800-944-0443 and speak to one of our California Medical Access Assistants
Immediately report the claim to Helmsman Management Services.
Helmsman Management Services:
■■
Issues the MPN employee notification letter
helmsmantpa.com
This brochure is a general description of services offered. See your contract for actual terms and conditions. No duty or
undertaking is intended or assumed by Liberty Mutual Insurance by this publication, as it is informational in purpose.
© 2015 Liberty Mutual Insurance, 175 Berkeley Street, Boston, MA 02116. 07/15
CALIFORNIA