Table of Contents Medical Judgment NetworksMCN contracts with over 20,000 physicians nationwide to provide services on a case-by-case basis. We provide administrative and support services to include recruitment and credentialing of consultants, scheduling of examinations, records acquisition and preparation, report transcription, quality assurance of reports, and transmittal of written findings to the clients.
The first contact that MCN customers have with MCN begins with the Scheduling Department. Usually when making a scheduling call, or ordering electronically, the requestor has already determined the specific medical specialty they feel is most appropriate to address the particular injury or condition in question. However, if the claims professional needs assistance choosing the right specialist(s), MCN staff has the expertise to help. Once the appropriate medical consultant is identified to address the customer’s needs, the appointment is scheduled. If desired, clients may be provided a copy of the physician consultants’ Curriculum Vitae. The system has the capability of verifying the location and distance of the provider from the claimant’s home. Physician Consultant Recruiting – If the claims professional is not satisfied with the selection of physician consultants available in a specific region, they may request that MCN recruit and orient a new consultant or they may nominate a specific physician for inclusion into the MCN physician consultant network. MCN’s Network Development Department immediately receives the assignment from the Customer Service Representative and usually completes a new recruiting assignment within two business days. MCN adds over 200 new physician consultants to its network per month. Specialty NetworksMCN has found that each market segment has its own unique requirements that vary by state, jurisdiction and insurance type. MCN designates providers for various types of assignments based on their licensing, credentials and training. MCN’s Workers’ Compensation Network – Depending on the state and jurisdiction, many states require that providers are specifically licensed with the state to undertake workers’ compensation examinations or peer reviews. MCN tracks these state credential requirements and assists in the training and credentialing of new physicians. If a selected provider does not meet the state requirements, MCN’s systems immediately notify the Customer Service Representative that the provider is not approved by the state, avoiding an improper referral. Additionally, many states have different rating methodologies; some use degree of disability, while others use impairment ratings with different benchmarks. Awareness of jurisdictional differences and training providers on the proper use of these systems is imperative when performing exams for a specific state, regardless of where the actual evaluation takes place.
MCN’s Auto/PIP/No-Fault Network - Different states have unique rules determining who can perform examinations or peer reviews on auto claimants. MCN tracks these requirements in its database to assure compliance with jurisdictional and state mandates. It is also important that providers have experience and understanding of soft- tissue injuries to appropriately comment on treatment concerns in many of these claims. Our network has a wide array of non-medical doctor (MD) specialties, including chiropractors, physical therapists, podiatrists, acupuncturists, naturopaths, and massage therapists. In many states the “like specialty” rules require that opinions regarding cases use the same type of provider that has been treating the claimant.
MCN’s Disability Network – Unlike other forms of insurance short and long-term disability programs are typically national in scope, serving large employee groups across the country, and regulated by federal standards. MCN is uniquely capable of handling these claims with east and west coast call centers .Providers are trained regarding the unique requirements of each Disability client and the proper concepts of disability assessment, including the importance of determining level of impairment. Additionally, when requested by clients, physicians may be asked to contact the treating provider as part of a disability assessment.
MCN’s Behavioral Health Network – Due to the growing number of mental health claims, MCN has built an extensive network of over 2,400 Behavioral Health consultants. This includes board-certified psychiatrists, neuropsychologists and psychologists. Provider HistoryTo assure the provider has a history of timeliness and few issues regarding quality, the MCN Customer Service Representative can review the provider performance. The MCN system reports the number of completed exams or reviews over the past 12 months along with the number of exams where rework was required. Data is provided on the average number of days between appointment dates and report completion. Provider Network CredentialingMCN uses a master database for primary source verification to confirm Board Certification, State licensure, residency training, medical school graduation and other data on our consultants. If the physician has had any reportable matters including licensure actions or malpractice settlements, we access the NPDB (National Practitioner Database) and review the specific facts to determine if the physician is a suitable consultant for MCN. MCN uses a “rolling re-credentialing” model. MCN may use consultant resources in remote areas or specialty types that are infrequently requested. It is imperative that these providers are fully credentialed prior to every evaluation to assure that they remain qualified for our Network.
Credentialing includes verification of: | | State Licensure – All state licenses are reviewed from each state in which the physician has practiced.
| | | Board Certification – Board certification is checked to determine if a Dr. is in good standing. MCN accepts Boards recognized by the American Board of Medical Specialties for medical doctors as well as several other Boards for non-MD’s.
| | | Professional Liability Insurance –MCN requires a proof of current insurance coverage.
| | | DEA License – MCN checks to confirm that the DEA license is in good standing. |
MCN utilizes the National Practitioner Database (NPDB) to review any adverse issues discovered in the credentialing process. Legal Proceedings – MCN utilizes the National Practitioner and State Databases to review and assess legal claims and disciplinary matters impacting a prospective consultant. Workers Compensation Treating NetworksMCN delivers one of the most sophisticated PPO management tools to its medical bill-review clients. Based on our client’s geographic needs MCN can configure an unlimited number of PPO networks down to a specific zip code. We take client claims data and analyze which group of networks has the deepest penetration and discounts in a given location. Using this data MCN develops a layered approach, giving our clients the maximum coverage and savings in a given region. Let MCN analyze your claims data to determine your company’s maximum savings configuration. Below are some of MCN’s PPO partners. Aetna
Blue Cross Blue Shield
CHN Solutions
CompPartners / CFMC
First Health
HFN
InterPlan WC
Indiana Health Network
MetraComp Certified NY
National Choice Care
OHARA
PPOM WC
ppoNext
PRIME
Rockport
Scripnet
Three Rivers (TRPN)
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