Nationwide Provider Network (NPN)

Graphic depicting medication bottles and a doctor's clipboard and stethoscope.

To schedule an appointment with a new provider, you must first call the MCA-Sedgwick call center at 1-800-416-2898. .

The Nationwide Provider Network (NPN) is a network of healthcare providers throughout the country who provide WTC-related services to members who live outside the New York metropolitan area.

Managed Care Advisors (MCA)-Sedgwick, a company under contract with the WTC Health Program, administers the NPN.

How Does the NPN Work?

The NPN operates differently than the Clinical Centers of Excellence (CCEs), which are based in the New York metropolitan area. Unlike the CCEs, the NPN has no central clinic. Instead, the contracted NPN administrator, MCA-Sedgwick, coordinates care for members using a network of individual providers or provider groups nationwide.

The NPN is made up of large networks including First Health and Prime Health Services, as well as individual providers. These provider networks have contracts with MCA-Sedgwick that allow the providers within these networks to offer services to NPN WTC Health Program members. However, not all providers in these networks are required to provide services to NPN WTC Health Program members. To be considered an In-Network Participating Provider, providers must agree to the WTC Health Program’s terms and conditions to ensure the WTC Health Program can cover the cost of the claims.

Understanding Providers and the Provider Network

When choosing a provider for your health services, you may have heard of "in-network" and "out-of-network" providers in relation to your health plan. However, it's important to note that being an "in-network" provider alone does not guarantee eligibility for reimbursement of claims. To be eligible for reimbursement, a provider must also be a "participating" provider who agrees to follow to the WTC Health Program's terms and conditions.

To better understand different types of providers in the WTC Health Program, see the table below:

Type of Provider	Definition	What this means
In-Network Participating Provider	A healthcare provider or provider group who has a contract with the WTC Health Program CCE Provider Network and/or the NPN and has agreed to the Program's terms and conditions to provide care to Program members.	Since they provider has agreed to the Program's terms and conditions, the Program will cover the costs of approved WTC-related care claims submitted by participating providers.
In-Network Non-Participating Provider	A healthcare provider or provider group who has a contract with the WTC Health Program CCE Provider Network and/or the NPN but has not agreed to the to the Program's terms and conditions.	Since the provider has not agreed to the Program's terms and conditions, the Program will not cover the costs of approved WTC-related care claims submitted by non-participating providers.
Out-of-Network (OON) Provider	A health care provider or provider group who does not have a contract with the WTC Health Program CCE Provider Network or the NPN.	Since the provider does not have a contract with either of the Program’s provider networks, the Program will not cover the costs of approved WTC-related care claims submitted by out-of-network Providers.

Frequently Asked Questions

Is there an online look-up tool to find a provider in the NPN?

There is no online NPN provider lookup tool available for members at this time. The NPN previously had a link on their webpage to a provider lookup tool. In January 2023, the Program decided to remove the NPN provider lookup tool because it is not customized for WTC-related care.

General lookup tools for Prime Health Services or First Health will show In-Network Providers but not specifically In-Network Participating Providers. If NPN members use this tool to find In-Network providers, they must confirm with the NPN that the provider is a participating in the Program.

If they are not an In-Network Participating provider, the WTC Health Program will not be able to reimburse any claims submitted for their services.

All NPN members must call the MCA-Sedgwick call center at 1-800-416-2898 for assistance finding a new In-Network participating provider. This will prevent any issues with the payment of bills for your WTC-related care and ensure that:

the provider is appropriate for your certified WTC-related health condition;
the treatment is approved by the Program; and
the provider is educated on and agrees to comply with the Program’s unique requirements (e.g., coordination of benefits, limited health benefit, FECA rates, etc.).

What can I do if my provider isn’t in the WTC Health Program’s Provider network?

Out-of-network providers do not have an agreement with any of the WTC Health Program's provider networks to provide care to Program members. Seeing an out-of-network provider will put you at risk of having to pay for your WTC-related care.

Please contact MCA-Sedgwick at 1-800-416-2898 for assistance in scheduling an appointment with a Participating provider.

If your Out-of-Network provider has expressed interest in joining our provider network, encourage them to visit our website to learn how to enroll.

How do I join the NPN?

Newly enrolled WTC Health Program members outside of the New York metropolitan area are automatically assigned to the NPN. The NPN is listed on their official Program enrollment welcome letter. MCA-Sedgwick then follows up with a welcome packet.

Existing members at a CCE may wish to transfer into the NPN when moving out of the New York metropolitan area. Detailed information on how to transfer into the NPN is on the Transferring Clinics page.

Please note: The WTC Health Program and the NPN only covers medically necessary healthcare services within the United States and its territories, including the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, American Samoa, and the Trust Territory of the Pacific Islands.

How do I use my NPN Member ID card?

Unlike members that go to a CCE, members of the NPN get an NPN member ID card from MCA-Sedgwick. The card shows the provider that the member is covered by the WTC Health Program.

NPN members should show their NPN ID card every time they see a provider for a WTC-related service. The card provides important member benefits and billing details to the provider and their staff.

If you do not have an NPN member ID card, please contact MCA-Sedgwick at 1-800-416-2898. You may also download a temporary NPN ID card through the NPN Member Portal .

Should I get a bill for WTC-related services as a member of the NPN?

No. WTC Health Program members, whether in the NPN or at a CCE, should never receive a bill for approved WTC-related services received through the Program. This includes copays and deductibles.

As an NPN member, if you receive a bill for a WTC-related service by mistake, do not pay it. Call MCA-Sedgwick at 1-800-416-2898 or submit the bill through the NPN Member Portal .

Learn more about what to do if you get a bill.

What is the NPN Portal?

The NPN Member Portal is a convenient online self-serve option provided by MCA-Sedgwick. It allows members 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:

ability to securely upload medical records
online versions of key NPN forms
messaging or live chatting the MCA-Sedgwick Member Services team

If you want to register for the portal or need to verify or give the NPN your current email address, please call 1-800-416-2898.

Contact Information

For NPN Members

WTC-Related Care:
For NPN services such as scheduling appointments, care and treatment, and case management, contact MCA-Sedgwick at 1-800-416-2898, option 1, or through their NPN Member Portal . The MCA-Sedgwick NPN call center is open Monday through Friday from 8am to 8pm ET.
You can also get more information on scheduling an appointment in the NPN on MCA-Sedgwick’s Appointment FAQ page .
Recent Bills:
If you receive a bill by mistake for services received on or after August 1, 2002, contact MCA-Sedgwick at 1-800-416-2898, option 1.
Past Bills:
For billing issues for services received before August 1, 2022, contact Logistics Health Inc. (now also known as OptumServe) at 1-877-498-2911.
Pharmacy:
For pharmacy benefits or issues filling a prescription, contact Express Scripts at 1-800-935-7179 or log into the Express Scripts website .
General:
For general questions or inquiries about the Program, contact the WTC Health Program call center at 1-888-982-4748.

For NPN Providers

For NPN billing on or after August 1, 2022, please contact Managed Care Advisors (MCA)-Sedgwick at 1-800-416-2898, option 2.

For NPN billing before August 1, 2022, please contact LHI at 1-877-498-2911.