In addition to information stored on our directprovider.com portal, the following links are provided on key states where Coventry offers network programs.
- Fully bundled program: Coventry acts as either the certified entity or the support for a client's certification by supplying all the services under the MCO regulations. We provide fully bundled MCO services in the following states: CT, FL, GA, IL, KY, NE, NJ, NY, OK, TX HCN and WV.
- Network only program, we provide all appropriate network documentation to support a client's certification. We provide network-only MCO services in the following states: AR, CT, CA, FL, GA, IL, KY, MA, MT, NE, NJ, OK, SD, TX and WV.
- See the state links below to access more information where appropriate.
California Senate Bill 899, signed in 2004, was a sweeping reform legislation package designed to significantly reduce workers’ compensation costs in the state. It allows for the creation and certification of Medical Provider Networks (MPNs).
If an employer chooses to use an MPN, they must notify their employees, and employees must seek treatment from physicians within the MPN. Coventry Workers’ Comp Services offers California MPN options to help meet these regulatory requirements.
CA UR Reviewer Guidelines
Physician and non-physician UR reviewers use medical care guidelines adopted pursuant to California Labor Code 5307.27 and 8CCR 9792.8. Guideline sets are evaluated annually by the Program Medical Director. The adopted California guidelines (MTUS) have presumptive weight in determining the review approval, modification, and delay or denial of outcomes.
The links to resources and documents below offer information for providers relative to California reforms.
The following CA documents can be found on directprovider.com >
Economic Profiling Policy
California Client List
California Impairment Ratings Requirements
Guidelines for Medical Reporting
California MPN Provider Reference Manual
To confirm which MPN(s) you participate in please visit our MPN Provider Information >
Physicians treating in the California workers' compensation system are required to follow the evidence-based recommendations in the DWC medical treatment utilization schedule (MTUS). Click here to find the California Division of Workers Compensation Physician Education module.
Notice to Illinois Participating Providers
This notice is for Illinois participating providers regarding a workers' comp/ auto settlement, a related contract addendum and a new Illinois workers' comp law.
The Illinois Provider Reference Manual and other documents can be found at directprovider.com
There are two separate legal entities under the Coventry umbrella that handle products and services in Minnesota, each with their own role and function.
Coventry Workers’ Comp Services (“CWCS”)
CWCS understands the challenges the current workers’ compensation environment and regulations present to our customers, and that developing a comprehensive solution to contain health care and disability costs can be a complex undertaking. CWCS provides employers, insurers and claims payors a variety national and state-specific medical management solutions that can help. These services include in-network and out-of-network medical claims review and re-pricing, access to specialized Preferred Provider Organizations ("PPOs"), early intervention and other cost management and related services. CWCS provides claims agent services and related activities; Coventry Rehabilitation Services, Inc. (“CRS”) provides Qualified Rehabilitation Consultant Services, as described in detail below.
Coventry Rehabilitation Services, Inc. (“CRS”)
CRS is a registered Qualified Rehabilitation Consultant Firm (“QRC Firm”) in Minnesota that provides statutory vocational rehabilitation services performed by Qualified Rehabilitation Consultants (“QRCs”) as well as disability case management (“DCM”) services. All services provided by CRS and its QRCs in Minnesota comply with state mandated rules, statutes and regulations.
A QRC is an objective participant, and conducts the rehabilitation consultation, writes the rehabilitation plan, including return to work goals and estimated costs for the claims adjuster, provides rehabilitation services, and guides the delivery of rehabilitation services by others. More specifically, the QRC may provide the following services: rehabilitation consultation, medical management, on-site job analysis, coordination of return to work (same or new employer), job modification, functional capacity evaluation, transferrable skills analysis, work evaluation, work hardening, job seeking skills training, job development, post placement follow-up, academic skills enhancement, vocational counseling, vocational testing, on the job training, labor market surveys, exploration of retraining, administrative duties (i.e. letter, reports or forms), attend legal proceedings, or incur other expenses. Examples of QRC prohibited activities include: authorizing medical services, auditing bills, promoting independent medical exams, among others.
CRS may also provide DCM services for workers’ compensation claims when the qualifying criteria for QRC services have not been met on a claim, but are provided pursuant to the parties’ agreement. DCM services may include: medical management, on-site job analysis, coordination of return to work (same employer), job modification, or other administrative duties (i.e. letters, reports or forms). Any individual performing DCM services on a claim that also holds a QRC registration should conform to the same standards of practice outlined above.
To learn more about workers’ compensation functions in Minnesota, please click these links below:
- Vocational Rehabilitation in MN: http://www.dli.mn.gov/WC/Vocrehab.asp
- Employee Guide to Workers’Compensation:http://www.dli.mn.gov/WC/PDF/eeguide2wc.pdf
- Rehabilitation Rules: https://www.revisor.mn.gov/rules/?id=5200
- Workers’ Compensation Statute: https://www.revisor.mn.gov/statutes/?id=178
- Official MN Workers’ Compensation State website: http://www.dli.mn.gov/workcomp.asp
In the state of Texas, Coventry has developed Health Care Network (HCN) solutions for employers who subscribe to the workers' comp system and fee-for-service programs for employers who do not subscribe.
Coventry's Health Care Network (HCN) in Texas is designed to provide employers greater control of injury care, reduce lost-time costs and improve medical only-lost time ratios. HCNs are offered only to employers who subscribe to the workers' comp system.
The TX Client list and Provider Reference Manuals for Coventry, First Health, Texas Star and Genex HCN's can be found at directprovider.com
Texas non-subscribers do not participate in the Texas Workers' Compensation system. Non subscribers must create their own occupational illness and injury plan and Coventry can support those employers by offering them a network to use as a part of their plan. These fee for service plans are not available to those who subscribe to an HCN plan regulated by the Texas Department of Insurance and/or Division of Workers' Comp.
Please contact Coventry for more details on our subscriber and/or non-subscriber offerings.
Texas Closed Pharmacy Resources
The Division of Workers’ Compensation has created a pharmacy resource web page providing information about the Texas closed pharmacy formulary, pharmacy fee guideline and other related pharmacy rules. The Texas closed pharmacy formulary is applicable to injuries occurring on or after September 1, 2011. The associated pre-authorization requirements will be applicable to certain legacy claims after September 1, 2013. http://www.tdi.state.tx.us/wc/pharmacy/index.html
Client Specific Information
- Texas Star Network (Texas Mutual Insurance)
- Liberty Mutual Health Care Network
- First Health / Constitution State Services LLC HCN
- First Health / Travelers HCN
- First Health / AIGCS TX HCN
- Zenith Health Care Network
- The Hartford Workers Compensation Health Care Network-FH
The following links are provided as a resource for all or many states: