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 customize our network 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.

Zenith’s online directory is used to find medical providers that participate in our California Zenith Medical Provider Network (ZMPN) and Texas Zenith Health Care Network (ZHCN). Providers listed in the ZMPN* and ZHCN are included in the applicable network only for locations listed. Treatment obtained at locations not listed in the network is considered out-of-network and may be subject to denial. The online directory also provides information on providers available in other select states. If you need to locate a provider in a state that is not available on the tool, please contact Provider Relations at 800-440-5020.

Find a Medical Provider

Note: This online directory is for reference only and is not authorization for treatment. Zenith claims specialists should be contacted for referral approval. Please contact our Provider Relations team at 800-440-5020 (option 3) or 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 does not warrant the accuracy of the directory information or the quality of the medical care. Please contact us at 800-440-5020 if you find a discrepancy in the directory.

*In California, 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.

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.

Zenith Service Vendor List

Zenith uses medical provider networks in California and Texas. If you participate in either the California Zenith Medical Provider Network (ZMPN) or the Zenith Texas Health Care Network (ZHCN), this section provides the information 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.

You are also required to comply with both Zenith and applicable state law’s governing utilization review. Failure to obtain preauthorization may result in denial of payment for services.

  • 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 SB1160 and the MTUS Drug Formulary. While payment will not be automatically denied, payment may be denied if retrospective review determines the requested treatment was not medically necessary.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:

  • BY MAIL:
    ZENITH INSURANCE COMPANY
    PO BOX 769
    WOODLAND HILLS, CA 91367

  • BY FAX:
    818-227-3057

  • Failure to submit documentation substantiating medical necessity may result in the RFA being rejected as INCOMPLETE.

  • Effective January 1, 2018, Zenith will no longer accept nor respond to any treatment request submitted to other addresses or through other means, including RFAs submitted through the electronic billing systems. Bills for services should be submitted separately from RFAs.

  • SB1160 and MTUS Drug Formulary Notice Letter mailed to providers on November 30, 2017. Providers should review this letter for basic information on changes that are occurring effective January 1, 2018.

ZMPN Providers

  • Providers who participate in the ZMPN are required to comply with Zenith’s ZMPN Participating Provider Requirements. Zenith will be enforcing its requirement that services be provided at network facilities more stringently in the future. If you’re not certain whether a facility is in the ZMPN or not, please contact Zenith Provider Relations at 800-440-5020 (option 3). It’s important that you ensure you have privileges at facilities that are within the ZMPN in order to meet Zenith requirements.

Texas

All Providers

  • Texas Preauthorization List – Preauthorization requests for both health care network and non-health care network services should be directed to UniMed Direct at 866-931-5100 or by fax at 800-281-5438.

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