Note:Fax routine requests (including elective surgical procedures) to: (714) 784-7475. Urgent requests may be called in to: (714) 784-4711.
Requests for physician specialists/specialty services must be written on the MSI Specialty referral form located on this website(Provider Downloads/Alerts) http://ochealthinfo.com/about/medical/providers/news; also view, Important Changes effective, September 1, 2009.
Where do I send MSI members for outpatient services?
Members must use MSI contracted facilities:
Capitated services (CT, PET and PET/CT, MRI, MRA and X-ray of the orbits) must be provided at West Coast Radiology service locations, or MSI contracted hospitals. These proceduresrequireauthorization.
Laboratory:These services are provided through Quest Diagnostics. For a list of service locations call (800) 377-8448, select option 2 and enter a zip code. Laboratory services may also be provided at contracted hospitals, anddo notrequire authorization.
Non-capitated services (routine X-ray, mammography, non-invasive ultrasound, cardiac tests [EKG, Treadmill, stress echo, nuclear studies] pulmonary function studies, barium enema/swallow, and intravenous pyelogram) may be performed in contracted hospitals or in the physician's office, and do not require authorization.
Are members required to have a primary care Physician?
All MSI members are required to have a Primary Care Physician (PCP) also known as a Medical Home.
Once eligibility is confirmed, members should call the MSI program's Patient Education Department (PED) at (800) 417-4262 Option 1 to request a PCP. The PCP is selected from a specific list (network) of physicians in private practice, and community clinics.
Note:Members who wish to continue with a PCP assigned in a prior eligibility period, may request the same assignment, provided the physician is still available.
Prescriptions must be obtained from Rxamerica and CVS/Caremark participating pharmacies. Most local pharmacies are participants. A list of pharmacy locations is available on this website(Provider Downloads/Alerts) http://ochealthinfo.com/about/medical/providers/news.
Note:Medications must be obtained from pharmacies in Orange County only.
Does the MSI program reimburse for services provided outside of Orange County?
MSI members must receive services within Orange County. Inrareinstances, servicesmaybe reimbursed if the medical condition/service is within the scope of covered benefits, and cannot be provided within the County. These cases are subject to prior-authorization and when appropriate, retrospective review.