HealthSmart MPN Clients:

To meet Medical Provider Network (MPN) regulatory requirements pertaining to obtaining acknowledgements for all physicians and groups that were contracted with HealthSmart’s Workers’ Compensation Network prior to August 27, 2014, below you will find HealthSmart’s MPN Client listing for review.  Please note, HealthSmart is not a certified MPN in the State of California and this form is not intended to be representative of HealthSmart acting in the capacity of an MPN.  HealthSmart, however, serves as a contracting agent/leased network for several MPN Clients/Applicants.  Below you will find a listing of HealthSmart MPN Client/Applicants.

·         By your participation in HealthSmart’s Workers’ Compensation network you are automatically eligible to be a participating provider in the MPNs listed below.  However, it is ultimately the decision of the MPN applicant to choose the physicians/groups that will participate in the MPN.

·         To check if the physician/group has been selected to participate in any of the below MPNs, where applicable, click on the hyperlinked MPN Applicant name and search for your practice name (may be listed by individual physician or group name).

·         If you would like to de-select participation eligibility for any of the MPNs listed below, please uncheck the box preceding the HealthSmart MPN Client name, certify at the bottom of the form, then click submit to have your election transmitted to HealthSmart; or print, sign and send the form to HealthSmart via email at west.region@healthsmart.com or fax at 214-574-2368.

·         HealthSmart will communicate your de-selection to the specific MPN client(s) and also send an email acknowledging and providing status of your request within thirty (30) days of receiving your de-selection request.

Name of Applicant Name of MPN MPN Client
ABM MPN Harbor Health Systems
ABM Industries Inc MPN Harbor Health Systems
CorVel MPN Corvel
CorVel MPN Corvel
CorVel MPN Corvel
CorVel MPN/ACE American/GB Corvel
MLB CA MPN Bunch CareSolutions
Randstad/ACEAm/Bunch MPN Bunch CareSolutions
Boeing Harbor Health Systems
Chuck E Cheese Harbor Health Systems
Family Dollar MPN Harbor Health Systems
Nestle Harbor Health Systems
Sunrise Senior Living MPN Harbor Health Systems
Luxottica Group MPN Harbor Health Systems
Standard Parking MPN Harbor Health Systems
Hilton Worldwide Inc (INSURED) MPN Harbor Health Systems
Albertson's MPN Harbor Health Systems
Cardinal Logistics MPN Harbor Health Systems
Insperity MPN Harbor Health Systems
Sonoco Products Company MPN Harbor Health Systems
Hertz/Thrift Dollar Harbor Health Systems
Packaging Corp. of America Harbor Health Systems
Alcoa Global Fasteners Inc. MPN Harbor Health Systems
GWOOD 2 LLC (dba Penske Auto) MPN Harbor Health Systems
Graham Packaging MPN Harbor Health Systems
Southwest Airline Co. MPN Harbor Health Systems
Irvine Company MPN Harbor Health Systems
Corvel MPN Corvel
Rollins MPN Harbor Health Systems
JC Penney MPN Harbor Health Systems
Rush Trucking Centers MPN Harbor Health Systems
Apogee Enterprises Inc. MPN Harbor Health Systems
CorVel MPN Corvel
CorVel MPN Corvel
Metal Management Inc MPN Harbor Health Systems
CorVel MPN Corvel
CorVel MPN Corvel
CorVel MPN Corvel
Mentor/AmHome/Bunch MPN Bunch CareSolutions
Verizon Communications Inc. MPN Harbor Health Systems
AIG American Home Assurance Company/Lowe's Bunch CareSolutions
American Zurich Insurance Company/CorVel MPN Corvel
Skilled Healthcare MPN Harbor Health Systems
Veritiv MPN Harbor Health Systems
Ross Stores Harbor Health Systems
CorVel MPN Corvel
ARCH/Big Lots/Bunch MPN Bunch CareSolutions
SWH Mimi's Caf� MPN Harbor Health Systems
Uni-Select MPN Harbor Health Systems
Dollar Tree MPN Harbor Health Systems
Bunzl PLC MPN Harbor Health Systems
CorVel MPN/Archer Daniels - Midland Corvel
Midwest/CorVel MPN Corvel
BBSI MPN Corvel
Rising Interplan MPN Rising Medical Solutions
CorVel MPN Corvel
The Care West MPN Status
DESC (DHL) Harbor Health Systems
Petco MPN Harbor Health Systems
Dr. Pepper/Snapple Group MPN Harbor Health Systems
Veolia Environment North America MPN Harbor Health Systems
CorVel MPN Corvel
CorVel/Chubb Kaiser Select MPN Corvel
CorVel MPN Corvel
CorVel/Chubb Kaiser Select MPN Corvel
CorVel MPN Corvel
CorVel/City of Barstow MPN Corvel
City of Monterey MPN Status
CorVel/City of Murrieta MPN Corvel
CorVel MPN Corvel
CorVel MPN Corvel
CorVel MPN Corvel
Clougherty Packing Company MPN 2CS
CorVel/Coachella VWD MPN Corvel
Commerce and Industry Insurance Company / Gallagher Bassett / CorVel MPN Corvel
CorVel MPN Corvel
Mentor/Commerce/Bunch MPN Bunch CareSolutions
Interplan Health Group Xerox/ACS CompIQ
CorVel MPN/County of Riverside Corvel
Corvel MPN Corvel
CorVel MPN Corvel
CorVel MPN/Discover Property & Casualty/LWP Corvel
Gallo-Status MPN Status
General Electric MPN Harbor Health Systems
EMC-MPN Status
CorVel MPN Corvel
CorVel MPN Corvel
CorVel/Chubb Kaiser Select MPN Corvel
CorVel MPN Corvel
CorVel MPN Corvel
CorVel/Chubb Kaiser Select MPN Corvel
CorVel MPN Corvel
CorVel MPN Corvel
CorVel MPN/Fidelity $ Guaranty/ LWP Corvel
CorVel HCO/CorVel HCO Select Corvel
CorVel MPN Corvel
Corvel MPN Corvel
Foster Farms Custom CorVel MPN Corvel
Foster Farms Custom CorVel MPN Corvel
QBE Insurance Group MPN Harbor Health Systems
The Procter & Gamble (SELF-INSURED) Plan Harbor Health Systems
Golden State Water Company MPN Harbor Health Systems
Goodwill Industries of San Diego County-Comp Care MPN Corvel
CorVel MPN Corvel
Granite State Insurance Company / Gallagher Bassett / CorVel MPN Corvel
CorVel MPN Corvel
CorVel/Chubb Kaiser Select MPN Corvel
CorVel MPN Corvel
CorVel MPN/GuideOne Corvel
Corelogic MPN Harbor Health Systems
Stericycle MPN Harbor Health Systems
CorVel/CCMSI/HA&I/SOI MPN Corvel
CorVel/HA&I/BB&T MPN Corvel
CorVel/HA&I/Caliber MPN Corvel
CorVel/HA&I/HMSHost MPN Corvel
CorVel/HA&I/Kirkland's MPN Corvel
CorVel/HA&I/Prime Healthcare MPN Corvel
Hartford/Regis/Bunch MPN Bunch CareSolutions
Hendrick Automotive Group MPN Harbor Health Systems
TBC Corporation MPN Harbor Health Systems
World Kitchen (WKI) MPN Harbor Health Systems
First American Title Insurance Co MPN Harbor Health Systems
The Schwans Food Company MPN Harbor Health Systems
Cenveo MPN Harbor Health Systems
Community Memorial Health Systems MPN Harbor Health Systems
Hartford MW Bunch MPN Bunch CareSolutions
Sonic Automotive MPN Harbor Health Systems
CorVel/HICM/TX Roadhouse MPN Corvel
Stanley Black & Decker MPN Harbor Health Systems
Heartland Express Inc of Iowa Harbor Health Systems
Hilton Worldwide Inc (SELF-INSURED) MPN Harbor Health Systems
Zurich American Insurance Company Genex Services
Intel Corporation MPN Harbor Health Systems
Kaiser Permanente/Harbor Net MPN Harbor Health Systems
Kaiser Permanente/Harbor Net MPN Harbor Health Systems
K-Mart Corporation Harbor Health Systems
La-Z-Boy MPN Harbor Health Systems
Les Schwab Tire Centers of California Inc. Harbor Health Systems
CorVel MPN Corvel
American Claims Management Inc. MPN American Claims Management
Lowe's Home Centers/Bunch MPN Bunch CareSolutions
CorVel MPN Corvel
American Claims Management Inc. MPN American Claims Management
Rising Interplan MPN Rising Medical Solutions
CorVel MPN Corvel
CorVel MPN Corvel
CorVel MPN Corvel
CorVel MPN Corvel
Monterey-Salinas Transit MPN Harbor Health Systems
CorVel MPN/National Interstate Insurance Corvel
CorVel MPN Corvel
National Union Fire Insurance Company of Pittsburgh PA/Gallagher Bassett/CorVel MPN Corvel
Nat'l Union/Tractor/Bunch MPN Bunch CareSolutions
Randstad/Nunion/Bunch MPN Bunch CareSolutions
CorVel MPN Corvel
Mentor/NewHampshire/Bunch MPN Bunch CareSolutions
TruGreen MPN Harbor Health Systems
CorVel MPN Corvel
New Hampshire Insurance Company Ltd./Gallagher Bassett/CorVel MPN Corvel
CorVel MPN Corvel
CorVel/Chubb Kaiser Select MPN Corvel
Genex-Reyes Holdings MPN Harbor Health Systems
Arissa Cost Strategies MPN Harbor Health Systems
American Airlines (AAI) MPN Harbor Health Systems
Viacom Inc MPN Harbor Health Systems
Arissa-Vallarta Supermarkets MPN Harbor Health Systems
Worldwide Flight Services (WFS) MPN Harbor Health Systems
Universal Service of America LP MPN Harbor Health Systems
Genex-Reyes Holdings MPN Harbor Health Systems
Davita/Healthcare Partners MPN Harbor Health Systems
Northrup Group MPN Harbor Health Systems
Advance Auto Parts MPN Harbor Health Systems
Sonepar MPN Harbor Health Systems
Arissa-Springfield Insurance Co MPN Harbor Health Systems
Keenan PRIME Advantage MPN Harbor Health Systems
Keenan PRIME Plus MPN Harbor Health Systems
Evolution Captive MPN Harbor Health Systems
Titan Insurance MPN Harbor Health Systems
Western Southern Life MPN Harbor Health Systems
Follett MPN Harbor Health Systems
J Crew MPN Harbor Health Systems
Pepsi Co Inc MPN Harbor Health Systems
California Joint Powers Insurance Authority (CJPIA) MPN Harbor Health Systems
CPC Logistics MPN Harbor Health Systems
Equian - CPC Logistics MPN Harbor Health Systems
Equian - ABC Supply MPN Harbor Health Systems
Ecology Auto Parts MPN Harbor Health Systems
Ascena MPN Harbor Health Systems
Conagra Foods Inc & Subsidiaries MPN Harbor Health Systems
William Sonoma MPN Harbor Health Systems
Arissa - Superior Grocers MPN Harbor Health Systems
CorVel MPN Corvel
CorVel MPN/Old Republic Corvel
CorVel MPN/Old Republic/LWP Corvel
Ryder/Bunch MPN Bunch CareSolutions
Eaton Harbor Health Systems
Veolia Transporation MPN Harbor Health Systems
AT&T MPN Harbor Health Systems
The Procter & Gamble (INSURED) Plan Harbor Health Systems
Wells Fargo & Company MPN Harbor Health Systems
Banfield Pet Hospital Harbor Health Systems
YRC Worldwide MPN Harbor Health Systems
McKesson Corporation MPN Harbor Health Systems
Eaton Harbor Health Systems
Orchard Bunch MPN Bunch CareSolutions
CorVel MPN Corvel
CorVel/Chubb Kaiser Select MPN Corvel
CorVel/Pasadena Unified School District MPN Corvel
American Claims Management Inc. MPN American Claims Management
Rising Interplan MPN Rising Medical Solutions
Pomona Unified School District/CorVel Select MPN Corvel
QBE Insurance Group MPN Harbor Health Systems
Rising Interplan MPN Rising Medical Solutions
CorVel MPN Corvel
CorVel MPN Corvel
Landmark Media MPN Harbor Health Systems
Trump National Golf Club Los Angeles MPN Harbor Health Systems
QBE Insurance Group MPN Harbor Health Systems
NFL MPN Harbor Health Systems
TNC Holdings MPN Harbor Health Systems
CorVel/Recology MPN Corvel
QBE Insurance Group MPN Harbor Health Systems
Atlas General MPN Harbor Health Systems
Zurich American Insurance Company Genex Services
CorVel MPN Corvel
CorVel MPN/Safety National Casualty/LWP Corvel
Pier One Imports MPN Harbor Health Systems
Vallarta Markets MPN Harbor Health Systems
Coach Inc MPN Harbor Health Systems
NBTY MPN Harbor Health Systems
San Diego CCD/CorVel Select MPN Corvel
CorVel/San Diego County Schools JPA MPN Corvel
The Status MPN-Save Mart Status
Scripps Health Harbor Health Systems
Securitas Security Services USA Inc MPN Harbor Health Systems
CorVel MPN Corvel
Kaiser Permanente/Harbor Net MPN Harbor Health Systems
The Rising Medical Solutions MPN Rising Medical Solutions
CorVel MPN Corvel
CorVel MPN Corvel
CorVel HCO/CorVel HCO Select Corvel
Rising Interplan MPN Rising Medical Solutions
Meadowbrook Harbor Health Systems
Starr Indemnity & Liability Company Harbor Health Systems
TWR Enterprises MPN Harbor Health Systems
CorVel MPN Corvel
QBE Insurance Group MPN Harbor Health Systems
Brookstone MPN Harbor Health Systems
Target Harbor Health Systems
Tenet Healthcare MPN Harbor Health Systems
CorVel MPN Corvel
CorVel MPN Corvel
CorVel MPN Corvel
The Insurance Company of the State of Pennsylvania / Gallagher Bassett / CorVel MPN Corvel
CorVel/Kroger Select MPN Corvel
Kroger MPN Harbor Health Systems
Genex/Interplan MPN Crum & Forster
The Procter & Gamble (SELF-INSURED) Plan Harbor Health Systems
The Procter & Gamble (SELF-INSURED) Plan Harbor Health Systems
Red Shield MPN Bunch CareSolutions
CorVel MPN Corvel
Rising Interplan MPN Rising Medical Solutions
POG (McDonalds) Harbor Health Systems
Chiquita Brands International MPN Harbor Health Systems
United Health Group MPN Harbor Health Systems
Express LLC MPN Harbor Health Systems
Media News MPN Harbor Health Systems
Turlock Irrigation District MPN Status
GENEX/Interplan MPN Crum & Forster
CorVel/UAL/Kaiser MPN Corvel
CorVel MPN Corvel
CorVel MPN/USF & G/ LWP Corvel
University of Southern CA (USC) Harbor Health Systems
USS-POSCO Industries Status
CorVel MPN Corvel
CorVel/Chubb Kaiser Select MPN Corvel
Rising Interplan MPN Rising Medical Solutions
Walt Disney Parks and Resort US Inc. MPN Harbor Health Systems
Rising Interplan MPN Rising Medical Solutions
Meadowbrook Harbor Health Systems
T-Mobile MPN Harbor Health Systems
CorVel MPN Corvel
Tractor/XLGroup/Bunch MPN Bunch CareSolutions
XL Specialty Insurance Genex Services
CorVel MPN Corvel
CorVel MPN/XL Specialty Insurance Company Corvel
Tatitlek MPN Harbor Health Systems
Cook Inlet Region Inc MPN Harbor Health Systems
CorVel MPN Corvel
Safelight Group Inc Harbor Health Systems
Elite Distributors Insurance Company (EDIC) MPN Harbor Health Systems


Name:          Phone:          Title/Position:

Physician/Group TID:

 

Certification:

By clicking submit, I hereby acknowledge and agree that I have read and understand my rights and obligations with HealthSmart’s MPN client list.  I understand that HealthSmart is not a certified MPN but by my participation in HealthSmart’s Workers’ Compensation PPO I am eligible to participate in HealthSmart’s Client affiliated MPN’s should I be elected by the MPN applicant to participate in the network.  I further understand, where applicable, that upon submitting a request to de-select participation in a specific HealthSmart Client MPN that HealthSmart shall communicate my request to the MPN Client and I shall be removed from the MPN within sixty (60) days of submitting my de-selection request to HealthSmart, and where applicable, I shall continue to treat any injured worker benefiting from the de-selected MPN that is in my care as an in-network physician/group until an appropriate coordination and transfer of care is complete. 



 

*HealthSmart’s MPN Client list may be updated from time to time.  At any time visit http://www.healthsmart.com to view HealthSmart’s most up to date client list.