Specialty Networks

MCN 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 Network Credentialing

MCN 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:

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.