Information for Providers

Helping You Provide The Best Possible Care

Information for Providers

An injured employee’s return to health is everyone’s goal, and building strong relationships with medical providers goes a long way in accomplishing this. At Zenith, we work with providers to help ensure providers are experienced in workers’ compensation and understand the care and services needed for industrial injuries.

As a Zenith network provider, you are part of a team that will work together to help injured employees obtain appropriate care to help achieve an optimal medical outcome. Zenith’s team of medical management professionals is available to work with you, the employer, and the injured employee to optimize communication, care, and return-to-work.

Use these links to locate other network providers and service vendors.

Find a Provider

Zenith’s online directory tool is used to find medical providers who participate in networks we utilize. In the tool, you can search by Address, Name, or Region.

Providers are included in the applicable network only for locations listed. Treatment obtained at locations not listed in the network is considered out-of-network. Out-of-network treatment is subject to denial where permitted by law. The online directory tool also provides information on providers available in other select states. If you need to locate a provider for a state that isn’t included in our tool, call Customer Service at 800-440-5020 and ask for Provider Relations.

opens in a new windowMedical Provider Directory

This online directory is for reference only and is not authorization for treatment. Zenith claims specialists should be contacted for referral approval. Please contact Customer Service at 800-440-5020 and ask for Provider Relations or contact Provider Relations by email at providergroup@thezenith.com.

Directory information is updated monthly and subject to change without notice. While we strive to maintain up-to-date provider demographics, Zenith doesn’t warrant the accuracy of directory information or the quality of the medical care. Please contact us at 800-440-5020 if you find a discrepancy in the directory.

Custom Networks for California and Texas
Providers listed for California participate in the Zenith Medical Provider Network ID# 3142 (ZMPN) and providers listed for Texas participate in the Zenith Health Care Network (ZHCN). Injured employees are required to obtain treatment from a provider in the ZMPN or ZHCN. Failure to treat in network may result in denial of payment. Referrals for treatment must also be made to providers within the applicable network. See the Policies and Procedures section for additional information and requirements.

California only: Zenith utilizes the Zenith Pharmacy Network and does not reimburse for office dispensing except in limited circumstances. Please see opens in a new windowCalifornia ZPN Pharmacy Lookup for more information.

A chiropractor cannot be the injured employee’s treating physician after the injured employee receives 24 chiropractic visits, unless Zenith has authorized additional visits in writing. The term “chiropractic visit” means any chiropractic office visit, regardless of whether services performed involve chiropractic manipulation or are limited to evaluation and management. If medical treatment is required after 24 chiropractic visits, a new physician who is not a chiropractor must be selected.

New Jersey and Pennsylvania Only
Zenith uses the Horizon Casualty Services, Inc. workers’ compensation network in New Jersey and certain contiguous counties in Pennsylvania when the injury arises in New Jersey but treatment is rendered by a Horizon provider in Pennsylvania. We use the Prime Health workers’ compensation network in Pennsylvania. If you participate in both networks, the following shows the order contracts will be applied:

The Prime Health contract applies to claims arising in Pennsylvania when treatment is rendered by an Prime Health participating provider in Pennsylvania;
The Horizon contract applies to claims arising in New Jersey when treatment is rendered by a Horizon participating provider and treatment is provided either in New Jersey or in one of the contiguous Pennsylvania counties.

Find an Ancillary Service Vendor

Zenith uses ancillary vendors to provide certain medical services to injured employees including services such as diagnostic imaging, durable medical equipment, physical therapy, and translation services. Texas and California only: Reimbursement may be denied for services provided outside of the applicable network. Providers that are contracted with an ancillary vendor are required to follow that vendor’s processes and procedures for the arrangement of services as well as billing. Failure to comply with the vendor’s processes may result in reimbursement being denied as out of network.

opens in a new windowZenith Service Vendor List

Policies and Procedures

Zenith uses networks in multiple states. All providers must comply with applicable state law as well as their contractual obligations. This includes providing treatment within medical treatment guidelines and utilization review requirements. Please be aware that in some states, failure to obtain preauthorization may result in denial of payment for services.

Zenith uses custom medical provider networks in California and Texas. If you participate in either the California Zenith Medical Provider Network ID# 3142 (ZMPN) or the Zenith Texas Health Care Network (ZHCN), you need to understand your rights and meet our network requirements. Failure to comply with Zenith’s requirements may result in removal from the applicable network. These requirements are set forth below.

All providers are required to treat within MTUS guidelines, MTUS Drug Formulary, or within other applicable evidence-based guidelines when MTUS does not apply. Providers must demonstrate the recommended treatment is medically necessary. Zenith requires treatment, including prescriptions that are not listed as Exempt on the MTUS Drug Formulary, to be authorized before treatment is rendered except as set forth in Labor Code 4610(b), the MTUS Drug Formulary, and corresponding regulations. While payment will not be automatically denied, payment may be denied if retrospective review determines the requested treatment was not medically necessary. Labor Code §4604.5(a) provides that MTUS is presumptively correct on the issue of extent and scope of medical treatment (including diagnostic services pursuant to California Code of Regulation §9767.3(c)(8). The presumption is rebuttable and may be contested by providing scientific medical evidence establishing that a variance from the guidelines reasonably is required to cure and relieve the injured employee from the effects of his or her injury.

Access to MTUS-ACOEM: On February 5, 2019, California’s Department of Industrial Relations, Division of Workers’ Compensation (DIR/DWC) announced that it’s providing free access to the MTUS-ACOEM practice guidelines and drug formulary to all providers who handle workers’ compensation cases for the State of California. This evidence-based content is being made available on a new website designed by ReedGroup’s MDGuidelines in conjunction with DIR/DWC. The website is called the opens in a new windowMDGuidelines CA MTUS-ACOEM Edition. It contains all of the adopted ACOEM guidelines, the MTUS Drug List, California regulations, and so much more. They even created state-of-the-art tools that make accessing appropriate treatment and drug recommendations fast and easy.

SUBMISSION OF TREATMENT REQUESTS: Treatment requests must be submitted using DWC Form RFA. The form must be correctly and completely filled out and submitted to Zenith along with documentation substantiating the medical necessity of the treatment at one of the following

Providers who participate in the ZMPN ID# 3142 are required to comply with Zenith’s ZMPN Participating Provider Requirements. All treatment is required to be provided within the ZMPN, including treatment at facilities unless treatment out of network is preauthorized by Zenith. Therefore, it is important that you ensure you have privileges at facilities that are within the ZMPN in order to meet Zenith requirements. Zenith’s directory is online. If you need assistance locating a network provider or verifying facilities that are in network, please contact Customer Services at 800-440-5020.

It’s important for you to update your demographic information. We rely on your information to direct injured employees to you, and it’s the only way for injured employees to find and select you.