Nationwide Provider Network Transition Information

MCA-Sedgwick now provides all NPN-related services. All new NPN members whether newly enrolled or transferring in from a Clinical Center of Excellence are assigned to MCA-Sedgwick. You can expect a welcome packet from MCA-Sedgwick in the mail shortly after receiving your enrollment letter from the WTC Health Program or confirmation of your transfer.

You should have received a welcome packet from MCA-Sedgwick in the mail in late July or early August. This packet included important information such as how to access the NPN Member Portal and how to contact MCA-Sedgwick. If you did not receive this packet, or you have any questions or concerns, please contact MCA-Sedgwick at 1-800-416-2898.

No, your WTC Health Program benefits did not change. You will continue to receive annual monitoring exams, cancer screenings, benefits counseling, and other benefits as outlined by Program policy. However, some operational aspects did change. This includes the NPN call center number, website and Member Portal, and care management team. Some members may also need to change providers.

We know that this change may present challenges and concerns. This is normal for a change such as this and we appreciate your patience.

The MCA-Sedgwick Member Services team is available to help answer your NPN questions or concerns at 1-800-416-2898. MCA-Sedgwick’s NPN website is available at www.sedgwickwtc.com .

No. Remember that the WTC Health Program is not insurance. The Program is a limited health benefits program only. That means that your primary health insurance (e.g., insurance through an employer, Medicare, or Medicaid) is separate from Program services and networks, including Nationwide Provider Network services.

You do not need to have a specific health insurance or change your health insurance to receive Program benefits through the NPN under MCA-Sedgwick. Remember though that the Program does require all members to have primary health insurance. This is a requirement of the Zadroga Act.

Important Note for Survivor Members: Personal health insurance is involved when the Program follows the legally required process called Coordination of Benefits. To fully cover any medical and/or pharmacy costs for Survivors, the Program-affiliated provider must bill your primary insurance first, including any public insurance such as Medicare or Medicaid, then any secondary insurance you may have. Finally, they bill the Program the remaining amount. This leaves no out-of-pocket cost to you. You do not need a specific insurer for the coordination of benefits process to occur. However, the Program provider that you see should also be in your primary health insurance network to ensure proper billing.

Most NPN members do  not  need to change providers. It is common for health providers to be in multiple networks. Many providers in the LHI network are already in the MCA-Sedgwick network, in addition to several new provider options.

MCA-Sedgwick has sent letters to select members before and after the transition date informing them of potential provider disruption. If you did not receive a letter, your Program provider is most likely in the MCA-Sedgwick network. If you have any questions or concerns about the status of your existing Program provider in the NPN, the MCA-Sedgwick Member Services team is available at 1-800-416-2898.

Also, all NPN members can look up a particular provider’s status by calling MCA-Sedgwick’s Member Services team or using the provider lookup tool in the NPN Member Portal .

Yes, MCA-Sedgwick sent letters to certain members in July and October informing them of potential provider disruption. This letter outlined next steps. These letters were based on claims and billing data from the last year and last 18 months respectively.

MCA-Sedgwick and the WTC Health Program worked hard to ensure all members seeing an out-of-network provider were notified by mail. However, in a complex transition such as this, there is a chance that a member with potential provider disruption did not receive a notification despite best efforts.

For this reason, if you already have a scheduled treatment appointment with an NPN provider, please call MCA-Sedgwick at 1-800-416-2898  before  you go to the appointment to verify the status of your provider. If possible, please call to verify the provider status 2 to 3 weeks before the appointment. This is extra important if the appointment is for a procedure that requires prior authorization from the WTC Health Program.

If you have an upcoming scheduled treatment appointment with an NPN provider, please call MCA-Sedgwick at 1-800-416-2898 before you go to the appointment. The MCA-Sedgwick team will check if the provider is in their network. If the provider is out of network, they will work with you right away on next steps.

If possible, please call MCA-Sedgwick 2 to 3 weeks before the appointment. This is extra important if the appointment is for a procedure that requires prior authorization from the WTC Health Program.

Please note: If MCA-Sedgwick scheduled your treatment appointment, you do not need to call to verify. MCA-Sedgwick only schedules appointments with providers in their network.

If a provider would like to join MCA-Sedgwick’s network, they can join any time. However, they must sign a contract to provide WTC-related care under MCA-Sedgwick. The amount paid to providers continues to be FECA rates, as it was under LHI.

You can tell your provider that more information on joining the MCA-Sedgwick network is available on their provider portal or by calling 1-800-416-2898, option 2.

Non-urgent transfer requests from a Clinical Center of Excellence (CCE) into the NPN may take a longer time to process than usual due to the complexity of this change.

Transfers out of the NPN were not affected during the transition.

The process to transfer into or out of the NPN has not changed. If you wish to transfer into the NPN, please contact your CCE. If you wish to transfer from the NPN to a CCE, please contact MCA-Sedgwick.

Learn more about Transferring Clinics.

The new NPN Member Portal is a convenient online self-serve option provided by MCA-Sedgwick that allows you to access information about your WTC Health Program NPN benefits and information. Use of the portal is optional.

Features of MCA-Sedgwick’s NPN Member Portal include a provider search tool to find or verify NPN participating providers in your area, ability to upload medical records, and key NPN forms that can be filled out online. You can also message or chat the MCA-Sedgwick Member Services team.

For existing members that were with LHI, this was known as LHI.Care. MCA-Sedgwick has their own portal with new and different features. Even if you had an LHI.Care account, you need to setup a new account in MCA-Sedgwick’s NPN Member Portal.

If you want to register for the portal and did not receive an invite on or after August 1–or want to verify or give the NPN your current email address–please call 1-800-416-2898.

All Responders and Survivors with a certified WTC-related health condition (Certified-Eligible Survivors) that transitioned care from LHI to MCA-Sedgwick should have received a new NPN ID card in your MCA-Sedgwick welcome packet at the end of July or early August.

If you have not received your ID card, please contact MCA-Sedgwick at 1-800-416-2898. MCA-Sedgwick has also made a temporary card available for download through your NPN Member Portal account. If you need access to the NPN Member Portal, please call 1-800-416-2898.

Now that MCA-Sedgwick operates the NPN, your LHI NPN Member ID card is no longer active. You can dispose of this card. We recommend cutting it up prior to disposal since it contains your personal information. Please use your new MCA-Sedgwick NPN Member ID card moving forward.

Please note: The NPN member ID card is a  separate  card from the WTC Health Program Pharmacy ID card. For WTC-related prescriptions, please use your WTC Health Program Pharmacy ID card from Express Scripts. That card is sent when you are certified with a WTC-related health condition.

If you mistakenly receive a bill for any WTC-related service received BEFORE August 1, 2022, or are still in the process of working through a billing issue with LHI, continue to contact LHI at 1-877-498-2911 even after the transition is complete.

For any bill mistakenly received for a WTC-related service received ON OR AFTER August 1, please contact MCA-Sedgwick.

With the transition to MCA-Sedgwick is complete, all NPN members should contact MCA-Sedgwick with questions or concerns. You can contact MCA-Sedgwick by phone or through their online NPN Member Portal.

The MCA-Sedgwick Member Services team is available at 1-800-416-2898 from 8am to 8pm ET Monday through Friday. Language assistance is available.

When MCA-Sedgwick’s call volume is high, wait times may be long. If prompted, please use the call back feature to save your place in line without holding. An MCA-Sedgwick representative will call you back once available. There is no need to hold or call back in later.

For online access, NPN members should no longer use LHI.Care. You need to set up an account on the new NPN Member Portal provided by MCA-Sedgwick. If you want to register for the portal, please call 1-800-416-2898.

Please note: LHI is still working on closing out some activities that occurred when they were overseeing the NPN (for example, billing issues from before August 1). You may hear from LHI or be directed to LHI by MCA-Sedgwick if necessary. If you mistakenly receive a bill for any WTC-related service received before August 1, contact LHI at 1-877-498-2911 even after the transition is complete.

The WTC Health Program and MCA-Sedgwick have worked hard to keep members informed throughout this transition. Now that the transition is complete, you can get the latest information on the Nationwide Provider Network page. You can also call MCA-Sedgwick with NPN questions or follow the WTC Health Program on Facebook or Twitter .

Previously, letters about the transition were also mailed to NPN members. These letters are available in English, Español, Polski, and 中文: :

• NPN Change Announcement Letter (February 2022)
• NPN Transition Extension Letter (April 2022)

As an NPN provider, who you should contact for billing-related questions depends on the date of service.

For services ON OR AFTER August 1, 2022, please contact Managed Care Advisors (MCA)-Sedgwick at 1-800-416-2898, option 2.

For services BEFORE August 1, 2022, you should still contact Logistics Health Inc. (LHI) at 1-877-498-2911, option 2.

No. The Program pays FECA rates for WTC-related services regardless of what company manages the NPN. Providers are paid FECA rates under MCA-Sedgwick just as they were under LHI.

As a provider, if you would like to join MCA-Sedgwick’s network, whether you were in the previous NPN network or not, you can join any time. A provider must first sign a contract to provide WTC-related care under MCA-Sedgwick. The amount paid to providers continues to be FECA rates, as it was under LHI.

To start the process or for more information, visit MCA-Sedgwick’s Providers page or call 1-800-416-2898, option 2.

Prime Network is part of Prime Health Services, a national managed care company that MCA-Sedgwick contracts with to help build their NPN provider network. Many legacy NPN providers under LHI were already able to provide services through Prime Network and Prime Health Services.

As a provider, if you are not currently part of the Prime Network and wish to join so that you can start or continue providing WTC-related services to WTC Health Program members, please visit MCA-Sedgwick’s Providers page or call 1-800-416-2898, option 2.

Important note for NPN members: WTC Health Program members should not contact Prime Health Services directly for WTC-related matters. For any member matter related to the NPN, including provider availability questions, please contact MCA-Sedgwick directly.

The WTC Health Program, like many other government programs, contracts with external organizations to provide certain services. This includes providing nationwide WTC-related health care to Program members through the NPN.

The existing NPN contract with Logistics Health Incorporated (LHI) ended in 2021. When a contract ends, any qualified vendor may submit a proposal to provide the contracted services. Proposals are evaluated in keeping with Federal acquisitions laws and regulations. MCA-Sedgwick was selected based on multiple factors after a complete review of all proposals.

Once a new vendor is selected, this starts a transition period where the previous vendor continues to provide services while work begins to transfer operations over to the new vendor. For the NPN, this transition period started late 2021 and finished on August 1, 2022.

The WTC Health Program also completed a transition of the Pharmacy Benefit Manager from Optum to Express Scripts on June 1, 2022. That is a separate transition from this NPN transition. More information on that transition is available on the PBM Transition Information page.

The transition was completed on August 1, 2022. MCA-Sedgwick mailed existing NPN members a welcome packet with more information in late July 2022. If you did not receive a welcome packet or have additional questions, please call MCA-Sedgwick at 1-800-416-2898.

Please note: As of August 1, NPN members can no longer access WTC Health Program benefits through LHI.

No. The Pharmacy Benefit Manager (PBM) change was a separate change from the NPN change. The PBM vendor for the WTC Health Program changed from Optum to Express Scripts on June 1, 2022. More information is available on the PBM Transition Information page.

Important: The WTC Health Program is aware of some member issues related to pharmacy benefits and prescription fills since the change to Express Scripts. Please visit Program Statement for Members Experiencing Issues Filling Prescriptions for more information.

Managed Care Advisors (MCA) is a company that specializes in managed healthcare, workers’ compensation, and disability management. MCA’s parent company is Sedgwick, sometimes also referred to as Sedgwick Government Services.

MCA and Sedgwick are working together to provide NPN services to the WTC Health Program.

Because they are partnered so closely and NPN members may interact with both companies, we refer to them as Managed Care Advisors-Sedgwick or MCA-Sedgwick for short.

The MCA-Sedgwick Member Services team can be reached at 1-800-416-2898 or through the new NPN Member Portal .

Yes. LHI has a separate contract with the WTC Health Program to operate the William Street Clinic in Lower Manhattan and that is still active. The change to MCA-Sedgwick from LHI for NPN operations  does not  affect the William Street Clinic in any way. There is no change for Survivors assigned to the William Street Clinic.

Important note: Members assigned to the William Street Clinic should continue to contact the clinic directly at 1-800-714-7426.