Table Of Content

Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2019. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * 99 Cents Only Stores LLC 4000 Union Pacific Avenue Self-Insured 1564 Commerce, CA 90023 Broadspire Signature MPN Employer 08/24/2009 T 99¢ Only Stores 4000 Union Pacific Avenue Self-Insured 1302 City of Commerce, CA 90023 WellComp Medical Provider Network Employer 07/31/2007 T A. Teichert & Son, Inc. 3500 American River Dr. Self-Insured 2301 Sacramento, CA 95851 WellComp Medical Provider Network Employer 06/11/2014 www.WellComp.com T A.B. Ag Services, Inc. 2020 So. East Ave Self-Insured 1751 Fresno, CA 93721 Zacky Farms Custom CorVel MPN Employer 01/12/2011 www.corvel.com T ABC Unified School District 16700 Norwalk Boulevard Self-Insured 0229 Cerritos, CA 90703 Prime Advantage Medical Network Employer 03/01/2005 T ABM Industries Incorporated 1775 The Exchange 6th Floor Self-Insured 0169 Atlanta, GA 30339 ABM ESIS MPN Employer 02/02/2005 T ABM Industries, Incorporated 1775 The Exchange, 6th Floor Self-Insured 1938 Atlanta, GA 30339 ABM MPN Employer 04/20/2012 T ACE American Insurance Company (Broadspire-Boeing MPN) 1601 Market Street 0080 Philadelphia, PA 19103 Broadspire MPN Insurer 03/07/2005 T ACE American Insurance Company 1 Beaver Valley Road Suite 4E 0716 Wilmington, DE 19803 Medex-ACE-GB Insurer 04/19/2005 T ACE American Insurance Company 1 Beaver Valley Road Suite 4E 1560 Wilmington, DE 19803 Wal-Mart-Medex MPN Insurer 08/13/2009 www.medexhco.com T ACE American Insurance Company 1601 Chestnut Street 0340 Philadelphia, PA 19103 Broadspire MPN Insurer 02/17/2005 T ACE American Insurance Company 1601 Chestnut Street 0384 Philadelphia, PA 19103 FARA-CVTY Insurer 04/21/2005 T Approved MPN Applications: 2434 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 1 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2019. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * ACE American Insurance Company 1601 Chestnut Street ACE American Insurance Company - Crawford 0677 Philadelphia, PA 19103 Select Insurer 06/16/2005 T ACE American Insurance Company 1601 Chestnut Street 0960 Philadelphia, PA 19103 Intracorp-Gates McDonald MPN Insurer 07/28/2005 T ACE American Insurance Company 1601 Chestnut Street 0983 Philadelphia, PA 19103 ACE-Medex Select B Insurer 08/05/2005 T ACE American Insurance Company 1601 Market Street First Health Comp America HCO Select 0394 Philadelphia, PA 19103 Network Insurer 03/16/2005 T ACE American Insurance Company 1601 Market Street 0125 Philadelphia, PA 19103 First Health CompAmerica Primary Network Insurer 04/13/2005 T ACE American Insurance Company 1601 Market Street First Health Comp America HCO Select 0506 Philadelphia, PA 19103 Network Insurer 04/21/2005 T ACE American Insurance Company 1601 Market Street MedInsights MPN accessing Prudent Buyer 0748 Philadelphia, PA 19103 PPO Insurer 04/29/2005 T ACE American Insurance Company 1601 Market Street ACE/Frank Gates First Health CompAmerica 0427 Philadelphia, PA 19103 Select Network Insurer 05/11/2005 W ACE American Insurance Company 436 Walnut Street 1826 Philadelphia, PA 19106 ACE GBMCS KOJ MPN Insurer 05/03/2011 T ACE American Insurance Company 436 Walnut St 0157 Philadelphia, PA 19106 Sedgwick CMS MPN Insurer 02/17/2005 T ACE American Insurance Company 436 Walnut St 0159 Philadelphia, PA 19106 Sedgwick CMS Extended MPN Insurer 02/17/2005 T ACE American Insurance Company 436 Walnut St 0646 Philadelphia, PA 19106 Genex Medical Provider Network (MPN) Insurer 06/02/2005 www.genexservices.com ACE American Insurance Company 436 Walnut St 1573 Philadelphia, PA 19106 Sedgwick CMS/Harbor Net - Ross Stores Insurer 12/14/2009 T Approved MPN Applications: 2434 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 2 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2019. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * ACE American Insurance Company 436 Walnut St 1581 Philadelphia, PA 19106 Coventry Network Insurer 01/21/2010 T ACE American Insurance Company 436 Walnut St 1623 Philadelphia, PA 19106 Sedgwick CMS/Harbor MPN - Ace CEC Insurer 04/20/2010 T ACE American Insurance Company 436 Walnut St 1650 Philadelphia, PA 19106 WellComp Medical Provider Network Insurer 06/22/2010 www.wellcomp.com T ACE American Insurance Company 436 Walnut St 1673 Philadelphia, PA 19106 Broadspire Signature MPN Insurer 08/10/2010 T ACE AMERICAN INSURANCE COMPANY 436 Walnut St ACE American Insurance Company-GENEX 1764 Philadelphia, PA 19106 MPN Insurer 02/01/2011 genexservices.com T Ace American Insurance Company 436 Walnut St 1961 Philadelphia, PA 19106 Sedgwick/Harbor MPN Insurer 05/15/2012 T ACE American Insurance Company 436 Walnut St. 0103 Philadelphia, PA 19106 ACE ESIS MPN Insurer 02/03/2005 T ACE American Insurance Company 436 Walnut St. 0768 Philadelphia, PA 19106 ACE/BUNCH Network Insurer 05/06/2005 T ACE American Insurance Company 436 Walnut St. 1605 Philadelphia, PA 19105 CorVel MPN Insurer 04/01/2010 T ACE American Insurance Company 436 Walnut St. 1734 Philadelphia, PA 19106 Medtronic CV Santa Rosa MPN Insurer 12/22/2010 T ACE American Insurance Company 436 Walnut St. 1857 Philadelphia, PA 19106 ACE/Bunch/Buffets MPN Insurer 07/15/2011 T ACE American Insurance Company 436 Walnut St., P.O. Box 1000 CCMSI/ACE First Health Comp America 1547 Philadelphia, PA 19105 Select HCO Network Insurer 06/25/2009 T ACE American Insurance Company 436 Walnut Street 0044 Philadelphia, PA 19106 Medex Insurer 12/07/2004 http://www.medexhco.com/ Approved MPN Applications: 2434 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 3 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2019. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * ACE American Insurance Company 436 Walnut Street 0391 Philadelphia, PA 19106 ACE/Gallagher Bassett/Coventry MPN Insurer 02/23/2005 www.talispoint.com/cvty/gbcvtympn ACE American Insurance Company 436 Walnut Street 0180 Philadelphia, PA 19106 TCT CA MPN Insurer 03/07/2005 www.mywcinfo.com T ACE American Insurance Company 436 Walnut Street Sedgwick First Health CompAmerica Primary 0361 Philadelphia, PA 19106 HCO Network Insurer 03/07/2005 T ACE American Insurance Company 436 Walnut Street Sedgwick First Health CompAmerica Select 0362 Philadelphia, PA 19106 HCO Network Insurer 03/07/2005 T ACE American Insurance Company 436 Walnut Street 0302 Philadelphia, PA 19106 CorVel MPN/ACE American/GB Insurer 03/14/2005 T ACE American Insurance Company 436 Walnut Street First Health CompAmerica Select HCO 0218 Philadelphia, PA 19106 Network Insurer 03/17/2005 www.talispoint.com/cvty/matrix ACE American Insurance Company 436 Walnut Street 0821 Philadelphia, PA 19106 TRISTAR MPN Insurer 05/03/2005 T ACE American Insurance Company 436 Walnut Street 0587 Philadelphia, PA 19106 INTRACORP Insurer 05/09/2005 W ACE American Insurance Company 436 Walnut Street 0404 Philadelphia, PA 19106 ACE/Gallagher Bassett/First Health MPN Insurer 05/13/2005 www.talispoint.com/cvty/gbfhmpnselect T ACE American Insurance Company 436 Walnut Street 0796 Philadelphia, PA 19106 ACE-Medex Select A Insurer 05/27/2005 T ACE American Insurance Company 436 Walnut Street 1014 Philadelphia, PA 19106 Genex Insurer 08/02/2005 www.genexservices.com ACE American Insurance Company 436 Walnut Street 0480 Philadelphia, PA 19106 Ace USA Cambridge MPN Insurer 09/12/2005 W ACE American Insurance Company 436 Walnut Street 1192 Philadelphia, PA 19106 Intracorp/ACE Insurer 05/02/2006 T Approved MPN Applications: 2434 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 4 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2019. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * ACE American Insurance Company 436 Walnut Street 1179 Philadelphia, PA 19106 Liberty Mutual Group MPN Insurer 06/01/2006 T ACE American Insurance Company 436 Walnut Street 1220 Philadelphia, PA 19106 Genex Insurer 07/21/2006 T ACE American Insurance Company 436 Walnut Street 1321 Philadelphia, PA 19106 INTRACORP/Customized ACE MPN Insurer 11/20/2007 T ACE American Insurance Company 436 Walnut Street 1380 Philadelphia, PA 19106 ACE/Bunch/Barnes Group MPN Insurer 05/14/2008 T ACE American Insurance Company 436 Walnut Street 1466 Philadelphia, PA 19106 Sedgwick CMS / Harbor Net - ACE Insurer 01/15/2009 T ACE American Insurance Company 436 Walnut Street 1434 Philadelphia, PA 19106 ACE GBMCS MPN Insurer 05/07/2009 www.talispoint.com/cvty/gbmpn ACE American Insurance Company 436 Walnut Street 1568 Philadelphia, PA 19106 Sedgwick CMS / Harbor MPN - Ace Boeing Insurer 10/20/2009 T ACE American Insurance Company 436 Walnut Street 1576 Philadelphia, PA 19106 MLB CA MPN Insurer 02/11/2010 T ACE American Insurance Company 436 Walnut Street 1620 Philadelphia, PA 19105 CorVel MPN Insurer 04/08/2010 T Ace American Insurance Company 436 Walnut Street 1846 Philadelphia, PA 19106 Wellcomp Medical Provider Network Insurer 06/16/2011 T ACE American Insurance Company 436 Walnut Street 1864 Philadelphia, PA 19106 ACE MPN - HCA Insurer 08/04/2011 www.talispoint.com/cvty/hcawc ACE American Insurance Company 436 Walnut Street 1995 Philadelphia, PA 19106 Sedgwick CMS / Harbor MPN - ACE FD Insurer 11/08/2011 T ACE American Insurance Company 436 Walnut Street Randstad/ACEAm/Conduent Care Solutions https://www.conduent.com/workers-compensation- solutions/ 1904 Philadelphia, PA 19106 MPN Insurer 02/14/2012 Approved MPN Applications: 2434 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 5 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2019. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * ACE American Insurance Company 436 Walnut Street 1909 Philadelphia, PA 19106 Sedgwick/Harbor MPN - ACE SUMC Insurer 02/14/2012 W ACE American Insurance Company 436 Walnut Street 1917 Philadelphia, PA 19106 Sedgwick/Harbor MPN - ACE Nestle Insurer 02/17/2012 T Ace American Insurance Company 436 Walnut Street 1975 Philadelphia, PA 19106 Sedgwick/Harbor MPN-ACE SSL Insurer 05/24/2012 W Ace American Insurance Company 436 Walnut Street 2055 Philadelphia, PA 91906 Sedgwick/Harbor 2 MPN Insurer 09/20/2012 T Ace American Insurance Company 436 Walnut Street 2070 Philadelphia, PA 19105 CorVel/Kaiser Select MPN Insurer 10/25/2012 www.corvel.com ACE American Insurance Company 436 Walnut Street 2181 Philadelphia, PA 19105 CorVel/Prime Healthcare MPN Insurer 06/18/2013 www.Corvel.com ACE American Insurance Company 436 Walnut Street 2227 Philadelphia, PA 19105 CorVel MPN Insurer 10/18/2013 www.corvel.com ACE AMERICAN INSURANCE COMPANY 436 Walnut Street 2259 Philadelphia, PA 19106 Iron Mountain/GENEX MPN Insurer 12/30/2013 T ACE American Insurance Company 436 Walnut Street 2249 Philadelphia, PA 19106 Coventry Medical Provider Network Insurer 04/18/2014 www.talispoint.com/cvty/matrix Ace American Insurance Company 436 Walnut Street 2286 Philadelphia, PA 19106 Sedgwick/Harbor 3 MPN Insurer 05/27/2014 www.harborsys.com/sedgwick3 T Ace American Insurance Company 436 Walnut Street 2287 Philadelphia, PA 19106 Sedgwick/Harbor 4 MPN Insurer 05/27/2014 www.harborsys.com/sedgwick4 T ACE American Insurance Company 436 Walnut Street 2316 Philadelphia, PA 19106 None Provided Insurer 07/03/2014 www.genexservices.com T ACE American Insurance Company 436 Walnut Street 2364 Philadelphia, PA 19105 ACE American/BBSI MPN Insurer 02/27/2015 www.barrettbusiness.com Approved MPN Applications: 2434 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 6 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2019. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * ACE American Insurance Company 436 Walnut Street 2422 Philadelphia, PA 19106 ALSCO Inc. Medical Provider Network Insurer 02/22/2016 www.talispoint.com/cvty/alsmpn ACE American Insurance Company 436 Walnut Street 2462 Philadelphia, PA 19106 Driscoll's MPN Insurer 03/25/2016 www.intermedccs.com/DriscollsMPN ACE American Insurance Company 436 Walnut Street 2423 Philadelphia, PA 19105 ACE/EI Pollo Loco MPN Insurer 04/21/2016 www.corvel.com ACE American Insurance Company 436 Walnut Street 2490 Philadelphia, PA 19105 ACE/Lineage MPN Insurer 06/21/2016 www.corvel.com ACE American Insurance Company 436 Walnut Street 2508 Philadelphia, PA 19105 CorVel/Cheesecake Factory MPN Insurer 10/28/2016 www.corvel.com ACE American Insurance Company PO Box 15059 First Health CompAmerica Select HCO 0838 Wilmington, DE 19850 Network Insurer 05/31/2005 T ACE Employers Insurance Company (CEI) 1601 Chestnut Street ACE Employers Insurance Company (CEI) - 0682 Philadelphia, PA 19103 Crawford Select Insurer 06/16/2005 W ACE Fire Underwriters Insurance Company 436 Walnut St. CCMSI/ACE First Health Comp America 1546 Philadelphia, PA 19105 Select HCO Network Insurer 06/25/2009 T Ace Fire Underwriters Insurance Company 436 Walnut Street 2206 Philadelphia, PA 19106 Liberty Mutual Group MPN Insurer 07/24/2013 T ACE Fire Underwriters Insurance Company 436 Walnut Street 2234 Philadelphia, PA 19106 Sedgwick/Harbor MPN - ACE Irvine Company Insurer 12/03/2013 T ACE Guaranty RE 1601 Chestnut Street 0681 Philadelphia, PA 19103 ACE Guaranty RE - Crawford Primary Insurer 06/16/2005 W ACE Indemnity/ACE American Insurance Company 1601 Market Street 0892 Philadelphia, PA 19103 CorVel MPN/ACE/LWP MPN Insurer 05/19/2005 T Approved MPN Applications: 2434 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 7 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2019. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * ACE Property and Casualty Insurance Company 436 Walnut St., PO Box 1000 CCMSI/ACE First Health Comp America 1548 Philadelphia, PA 19105 Select HCO Network Insurer 06/25/2009 T ACIG Insurance Company 2600 No. Central Expressway, Ste 800 0899 Richardson, TX 75080 Medex Insurer 07/01/2005 www.medexhco.com ACWA/JPIA 5620 Birdcage Street Joint Powers 0589 Citrus Heights, CA 95610 ACWA/JPIA MPN Authority 05/09/2005 W Administrative Concepts Corp. 406 43rd St West Self-Insured 1689 Bradenton, FL 34209 Broadspire Signature Employer 08/19/2010 T Administrative Office of the Courts 455 Golden Gate Avenue 1865 San Francisco, CA 94102 CorVel MPN State 08/23/2011 T Advance Auto Parts 5673 Airport Road MedInsights Medical Provider Network Self-Insured 0749 Roanoke, VA 24012 accessing Prudent Buyer HCO Employer 04/29/2005 W Advantage Workers Compensation Insurance Company P.O. Box 571918 Advantage Workers Compensation Insurance 1304 Salt Lake City, UT 84157 Company Medical Provider Network Insurer 09/13/2007 T Advantage Workers Compensation Insurance Company PO Box 57198 3104 Salt Lake City, UT 84157 WCF Insurance / Advantage MPN Insurer 06/20/2018 www.wcfmpn.com AIG Casualty Company fka Birmingham Fire Insurance Company of Pennsylvania 175 Water Street 0528 New York, NY 10038 Chartis - Cambridge MPN Insurer 03/24/2005 W Entity that AIG Claims, Inc. provides 175 Water Street, 18th Floor physician 3003 New York, NY 10038 AIG Select Advantage network services 03/03/2017 http://www.talispoint.com/aig/mpnselect/ Entity that AIG Claims, Inc. provides 175 Water Street, 18th Floor physician 3054 New York, NY 10038 AIG EP MPN network services 10/27/2017 www.talispoint.com/aig/EP Approved MPN Applications: 2434 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 8 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2019. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * Entity that AIG Claims, Inc. provides 175 Water Street, 18th Floor physician 3072 New York, NY 10038 AIG JCP MPN network services 12/11/2017 www.talispoint.com/aig/jcp Entity that AIG Claims, Inc. provides 175 Water Street, 18th Floor physician 3002 NY, NY 10038 AIG Primary Advantage network services 03/06/2017 www.talispoint.com/aig/com AIG Property Casualty Company 175 Water St - 18th Floor 2042 New York, NY 10038 Sedgwick/Harbor MPN - CHARTIS EPS Insurer 08/16/2012 T AIG Property Casualty Company 175 Water St 18th Floor 1658 New York, NY 10038 Broadspire Signature Network Insurer 06/23/2010 T AIG Property Casualty Company 175 Water Street - 18 Floor 1407 New York, NY 10038 CorVel MPN Insurer 08/06/2008 www.corvel.com AIG Property Casualty Company 175 Water Street - 18th Floor 0115 New York, NY 10038 AIG Primary MPN Insurer 02/17/2005 www.talispoint.com/aig/com AIG Property Casualty Company 175 Water Street - 18th Floor 1986 New York, NY 10038 Sedgwick/Harbor 2 MPN Insurer 06/01/2012 T AIG Property Casualty Company 175 Water Street – 18th Floor 1978 New York, NY 10038 Sedgwick/Harbor MPN Insurer 05/24/2012 T AIG Property Casualty Company 175 Water Street, 18th Floor 1757 NY, NY 10038 AIG Select MPN Insurer 01/19/2011 www.talispoint.com/aig/mpnselect AIU Insurance Company 175 Water Street - 18th Floor 0116 New York, NY 10038 AIG Primary MPN Insurer 02/17/2005 www.talispoint.com/aig/com AIU Insurance Company 70 Pine Street 0526 New York, NY 10270 Cambridge-Concentra MPN Insurer 03/23/2005 W AIU Insurance Company 70 Pine Street AIU Insurance/Gallagher Bassett/Concentra 0649 New York, NY 10270 MPN Insurer 03/24/2005 W Approved MPN Applications: 2434 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 9 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2019. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * AIU Insurance Company 70 Pine Street 0465 New York, NY 10270 Broadspire MPN Insurer 04/26/2005 T AIU Insurance Company 70 Pine Street MedInsights/GAB Robins Medical Provider 0919 New York, NY 10270 Network, accessing Prudent Buyer HCO Insurer 05/19/2005 W AIU Insurance Company 70 Pine Street 1025 New York, NY 10270 AIU Gallagher Bassett First Health Select MPN Insurer 08/05/2005 W AIU Insurance Company AIG 70 Pine Street 0855 New York, NY 10270 AIU Insurance Company, Crawford Select Insurer 07/01/2005 W AIU Insurance Company AIG 70 Pine Street 0864 New York, NY 10270 AIU Insurance Company, Crawford Select Insurer 07/01/2005 W AIU Insurance Company Chartis 32 Old Slip 19th FL 0610 New York, NY 10006 AIG ESIS MPN Insurer 03/28/2005 T AIX, Inc. 2 Waterside Crossing, Suite 400 1326 Windsor, CT 06095 AIX/Gallagher Bassett/First Health MPN Insurer 11/16/2007 W AIX, Inc. 2 Waterside Crossing, Suite 400 1328 Windsor, CT 06095 AIX/Gallagher Bassett/Coventry MPN Insurer 11/16/2007 W Alameda Contra Costa Transit District 1600 Franklin St. Self-Insured 1697 Oakland, ca 94612 AC Transit MPN Employer 09/29/2010 www.actransitmpn.com T Alameda County Schools Insurance Group 5776 Stoneridge Mall Road, Suite 130 Joint Powers 0767 Pleasanton, CA 94588 ACSIG/AccessMedical Provider Network Authority 05/19/2005 T Alameda County Schools Insurance Group P O Box 2487 Joint Powers 1345 Dublin, CA 94568 PRIME Plus Medical Provider Network Authority 01/28/2008 T Alameda County 1106 Madison Street Self-Insured 1032 Oakland, CA 94607 First Health CompAmerica Primary Network Employer 08/12/2005 T Alameda Health System 7677 Oakport Street, Suite 1200 Self-Insured 1780 Oakland, CA 94612 Alameda Health System MPN Employer 02/03/2011 http://www.talispoint.com/AHS Approved MPN Applications: 2434 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 10

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Oct 11, 2005 Approval. Mailing Address. MPN. Approval. Status *. 0125 ACE American Insurance Company. First Health CompAmerica Primary Network.

Medical Provider Networks Approved by DWC - California PDF

194 Pages·2016·0.9 MB·English

by Jeanne Lum

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Oct 11, 2005 Approval. Mailing Address. MPN. Approval. Status *. 0125 ACE American Insurance Company. First Health CompAmerica Primary Network.

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Publication Year:	2016
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Language:	English
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