Regulatory

Hortica California Signature MPN
The Hortica California Signature MPN will not be used for dates of injury on or after 07/15/2016.

Hortica MPN
The Hortica MPN is effective for dates of injury on or after 12/15/2016.

A medical provider network is a network of providers, including physicians, created to provide medical treatment for work injuries of employees in California. An MPN must be approved by the California Division of Workers’ Compensation (DWC) before it can be used. Unless exempted by law or the employer, all medical care for workers injured on the job whose employer has an approved MPN will be handled and provided though the MPN.

The Hortica MPN participating provider listing can be accessed at: https://www.goperspecta.com/VPD/sentry/public

MPN Medical Access Assistants
The Hortica MPN medical access assistants can assist injured workers with finding an MPN physician of their choice and with scheduling medical appointments. They can also provide injured workers with a copy of any MPN notice.
Medical access assistants are available Monday through Saturday, 7:00 am through 8:00 pm Pacific Time.

You may reach a medical access assistant by phone, fax or email.

• 855-346-4866, then press 3
• 800-999-4642 attention: medical access assistants
• ClaimsCAMPN@hortica.com

MPN Contacts

The Sentry MPN contacts can answer your questions, respond to your concerns about the Medical Provider Network, and assist employees in arranging for an MPN independent medical review.

The MPN contacts can be reached as follows:

• Telephone: 855-346-4866, then press 4
• Mailing Address: Sentry Insurance, Attn: MPN Contacts, PO Box 8032, Stevens Point, WI 54481
• Fax: 800-999-4642, attention: MPN Contacts
• Email: ClaimsCAMPN@hortica.com, attention: MPN Contacts

If you are a provider and interested in submitting medical bills electronically, please review the Clearinghouse and Payer ID in the sections below to ensure accurate routing of bills.

Workers’ Compensation Claims – All States

Medical and Dental Bills
Florists’ Mutual Insurance Company and Florists’ Insurance Company currently accepts electronic billing from medical providers on Workers’ Compensation claims. Medical providers will need to include Florists’ Mutual Insurance Company and Florists’ Insurance Company’s Workers’ Compensation Payer ID – J1417 and the patient’s Workers’ Compensation claim number with their submission.

Clearinghouse: Jopari
Suite 500, 1855 Gateway Boulevard
Concord, CA 94520 866-269-0554
eBill Enrollment: 866-269-0554
Customer Care: 800-630-3060
http://www.jopari.com/ebill-sign-up-form/

Workers’ Compensation Payer ID: J1417

For questions regarding Medical Bills or Reimbursements:
Medical and Dental Providers may contact 1-800-851-7740 Option # 1 for Claims then Option # 3 for validation of claim numbers.

Pharmacy Bills
Florists’ Mutual Insurance Company and Florists’ Insurance Company partners with Optum Pharmacy Benefits Management Program to process pharmacy invoices submitted electronically.
Contact: Optum
11000 Optum Circle
Eden Prairie, MN 55344
Phone: 1-877-470-9572
helpdesk3@optum.com
www.workcompauto.optum.com

Pharmacy Payer ID: Optum (PBM) BIN 004261 and Optum (PBM) PCN CAL

For questions regarding Pharmacy Bills or Reimbursements contact Optum:
Phone: 1-877-470-9572
Fax: 1- 888-579-0034
Email: helpdesk3@optum.com
Website: www.workcompauto.optum.com

Auto, Property & Casualty Claims – State of Minnesota, only

Medical, Dental, and Pharmacy Bills
Florists’ Mutual Insurance Company and Florists’ Insurance Company partners with Jopari to process medical, dental and pharmacy invoices submitted electronically. Florists’ Mutual Insurance Company and Florists’ Insurance Company’s Payer ID is C1033

Clearinghouse: Jopari
Suite 500, 1855 Gateway Boulevard
Concord, CA 94520
Phone: 866-269-0554
Website: www.jopari.com

Auto, Property & Casualty Payer ID: C1033

For questions regarding Medical Bills or Reimbursements:
Medical, Dental and Pharmacy providers may contact Florists’ Mutual Insurance
Company at 1-800-851-7740.

 

Minnesota Providers

Minnesota SB2193 requires Workers Compensation Carriers to provide the following information to Minnesota Workers Compensation Providers effective January 1, 2016.

Payer Information:
Claims Department
1800 North Point Drive
PO Box 8032
Stevens Point, WI 54481
1-800-851-7740
www.Hortica.com

Medical Bill Clearinghouse Information:
Medical and Dental Bills:
Florists’ Mutual Insurance Company and Florists’ Insurance Company partners with Jopari to process medical and dental invoices submitted electronically.

Payer ID:
Florists’ Mutual Insurance Company and Florists’ Insurance Company Payer ID with
Jopari is J1417. The Payer Identification number is populated in the 5010 ASCX12 837
TRs as follows:
Loop 2010BB Payer Name
NM108-PI (qualifier)
NM109=Payer ID number.
Reference Source: 5010 ASCX12 837 TR3 Implementation Guide available at http://www.wpc-edi.com/

Jopari’s Contact Information:
Address:
Jopari
Suite 500, 1855 Gateway Boulevard
Concord, CA 94520
Phone:
Customer Care – (800) 630-3060 option 2
Ebill Enrollment – (866) 269-0554
Email:
support@jopari.com
Website:
www.jopari.com

Claim Identification:
Medical and Dental Providers may contact Florists’ Mutual Insurance Company and Florists’ Insurance Company at 1-800-851-7740 Select option 1 – Claims and then select Option 3 – Existing Claim for validation of claim numbers.
Medical providers contracted with Jopari may utilize the Jopari Provider Portal @ www.jopari.com or contact Florists’ Mutual Insurance Company and Florists’ Insurance Company at 1-800-851-7740 Select option 1 – Claims and then select Option 3 – Existing Claim for validation of claim numbers.

Medical and Dental Invoice Submission:
Claim Identification number is reported in the 5010 ASC X12 837 TRs as follows:
Loop 2010 CA Patient Name
REF Segemnts=Property and Casualty Claim Number
REF01=Y4 (qualifier)
REF02+Claim Number
Reference Source: 5010 ASCX12 837 TR3 Implementation Guide available at http://www.wpc-edi.com/

Pharmacy Bills:
Florists’ Mutual Insurance Company and Florists’ Insurance Company partners with Optum Pharmacy Benefits Management Program to process pharmacy invoices submitted electronically.

Payer ID:
Florists’ Mutual Insurance Company and Florists’ Insurance Company Pharmacy Payer ID is Optum (PBM) BIN 004261 and Optum (PBM) PCN CAL.

Optum Contact Information:
Address:
Optum
11000 Optum Circle
Eden Prairie, MN 55344

Phone: 1-877-470-9572
Email: helpdesk3@optum.com
Website: www.workcompauto.optum.com

Claim Identification:
Pharmacy Providers may contact Florists’ Mutual Insurance Company and Florists’ Insurance Company at 1-800-851-7740. Select option 1—Claims and then select Option 3—Existing Claim for validation of claim numbers.

Beginning January 1, 2015, North Carolina requires Workers’ Compensation carriers to offer electronic payment to medical providers.

If you are a Workers’ Compensation Medical Provider and would like to receive payments via Electronic Funds Transfer (EFT) select an enrollment option after agreeing to the following terms:

Provider agrees to the following: This Authorization is between the Provider listed below (Provider) and Florists’ Mutual Insurance company, a member of the Sentry Group (“Florists’ Mutual Insurance company”) and governs Provider’s enrollment and use of the Electronic Funds Transfer (“EFT”) service. The contact person identified on the Authorization warrants and represents that he/she is authorized to act on behalf of the Provider and that his/her acceptance of the terms of this Authorization creates a legally enforceable obligation of the Provider. Provider authorizes Florists’ Mutual Insurance company to electronically transfer funds for all eligible and authorized claim payments to the bank account provided and understands that upon activation of the EFT service, Provider will no longer receive paper checks for claims payments. Provider warrants and represents that all information listed on this Authorization is accurate and agrees to immediately notify Florists’ Mutual Insurance company of any changes to the information or if it wishes to cancel enrollment. Florists’ Mutual Insurance company is not liable for any loss that Provider may incur as a result of the EFT service. Provider agrees to indemnify Florists’ Mutual Insurance company from and against all suits, claims, or losses arising from or alleged to arise from the Provider’s use of the EFT service. This Authorization constitutes the entire agreement between Florists’ Mutual Insurance company and Provider for the EFT service.

Please note:

• Please allow Florists’ Mutual Insurance company 7-14 days from receipt of all documentation to process EFT remittance, changes, or cancellation requests.
• Contact your financial institution to arrange for the delivery of the CORE-required Minimum CCD+ data elements needed for reassociation of the payment and the ERA.
  (The Corporate Credit or Debit is an ACH standard for EFT which is used to make/collect payments to/from other corporate entities. The CCD+ ACH Standard can include one record of payment-related information of up to 80 characters. Health Plans use the CCD+ to send payments via EFT, with a reassociation number that matches the EFT to its associated ERA (Electronic Remittance Advice))
• Mail your completed form to:
  Florists’ Mutual Insurance company
  PO Box 8032
  Stevens Point, WI 54481

Enrollment Options:

• Agree to the terms above and to enroll online
• Print an enrollment form

Enrollment Help Guide 

If you have any questions, or wish to determine the status of your enrollment, please contact the EFT enrollment team at 855-477-6832 x 7153466385