California Medical Provider Network

Church Mutual has partnered with Anthem to provide access to an extensive Medical Provider Network (MPN). The MPN includes physicians who understand workers’ compensation requirements and are experienced in providing expert care for injured employees.

How does the MPN benefit you and your employees?

The MPN improves the treatment process for injured employees and provides greater control over medical care for employers and employees throughout the life of a claim.

What are your responsibilities as an employer?

In order to implement the MPN for your organization, certain notices must be distributed and/or posted. These documents, along with other California claim-related documents, are included below.

How do I find a physician in Church Mutual's MPN?

To access the MPN Directory, click here.

Our Medical Access Assistant (MAA) is available Monday through Saturday, from 7:00 a.m. to 8:00 p.m., Pacific Standard Time to help schedule appointments:

Church Mutual MAA toll-free number:  (855) 890-4958

Church Mutual MAA fax:  (855) 273-6841

Email:  churchmutualmaa@anthemwc.com

What if I have questions about the MPN, or have a complaint?

The MPN coordinator/contact can be reached by phone at (800) 554-2642, ext. 3510, email at campn@churchmutual.com, fax at (715) 539-4651 or mail at 3000 Schuster Lane, Merrill, WI 54452.

How do I obtain a copy of medical provider network notifications that are to be given to employees? Examples of notifications are titled "Covered Employee Notification of Rights," "Transfer of Care Policy" or "Continuity of Care Policy."

Many of the required notices are available for download on this website (below), however, you also can contact the MPN coordinator/contact, noted above, to inquire about other notifications.

 

 


Forms

Document 1: Covered Employee Notification of Rights (English)

This document must be posted at each of your California locations at the time of MPN implementation. Church Mutual also will supply a copy of this document to your employee at the time of injury, upon receiving the notice of a new claim.

View and Print

Document 2: Covered Employee Notification of Rights (Spanish)

This document must be posted at each of your California locations at the time of MPN implementation. Church Mutual also will supply a copy of this document to your employee at the time of injury, upon receiving the notice of a new claim.

View and Print


To locate the following California claim-related documents, click here:

  • Form 5020 — Employer's Report of Occupational Injury or Illness
  • DWC 1 — Workers' Compensation Claim Form (English and Spanish)
  • DWC 7 — Notice to Employees (English and Spanish)
  • Time of Hire Pamphlet — Facts about Workers' Compensation (English)
  • Time of Hire Pamphlet — Facts about Workers' Compensation (Spanish)
  • Awards

    Awards and accreditations for Church Mutual.

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Church Mutual Insurance Company | P.O. Box 357 | 3000 Schuster Lane | Merrill, WI 54452-0357 | Telephone (800) 554-2642 or (715) 536-5577 | Copyright 2017