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Does MSI have an Authorization Department?
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Is a contract necessary to provide services?
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Where do I send MSI members for outpatient services?
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How does a provider register with the MSI program?
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Are members required to have a primary care Physician?
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May a Member change their PCP after assignment?
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How does a member change their PCP?
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May any physician provide primary care services?
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How do I check MSI member eligibility?
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Where do I submit claims?
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Does MSI have a billing deadline?
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Where do members obtain prescriptions?
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Does the MSI program reimburse for services provided outside of Orange County?
1. Does MSI have an Authorization Department?
Yes. This department provides authorization (tracking numbers) and coordinates:
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Referrals to physician specialists
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Surgical procedures (in/out patient)
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Hospital admissions/concurrent review
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Outpatient procedures (including, capitated
services, infusion therapy, wound care)
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SNF placement
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Hospital diversion
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Hospital discharge needs.
Note: Fax routine requests (including elective surgical procedures) to: (714) 634-5169 or (714) 978-2367. Urgent requests may be called in to: (714) 634-5169.
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/medical/msi/providers/news.htm; also view, Important Changes effective, September 1, 2009.
2. Is a contract necessary to provide services?
Please note the following:
Physicians:
Durable Medical Goods:
Home Health:
Imaging/Laboratory (see below):
3. Where do I send MSI members for outpatient services?
Members must use MSI contracted facilities:
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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 procedures
require authorization.
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, and
do not require authorization.
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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.
Note: A list of contracted hospitals is available in the MSI Provider Manual on this website
(Provider Downloads/Alerts).
4. How does a provider register with the MSI program?
Providers may register on-line at the following address:
https://ochca.amm.cc/register.aspx
If you require help with the registration process, please call Advanced Medical Management (AMM), MSI program’s billing agent, at (800) 206-6591 for assistance.
5. 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.
6. May a member change their PCP after assignment?
Members may change their PCP once within the first 30 days of their current eligibility and once every six months, thereafter.
Note: Services received from a PCP other than a
members’ assignment, will be denied.
7. How does a member change their PCP?
Members may call the MSI program’s Patient Education Department (PED) at 800-417-4262, option 1.
8. May any physician provide primary care services?
No. Primary care services may only be provided by the Program’s PCP (Medical Home) Network. This list is available on this website
(Provider Downloads/Alerts)
http://ochealthinfo.com/medical/msi/providers/news.htm.
Phone:(714) 834-4775 or e-mail:
svrungos@ochca.com
9. How do I check MSI member eligibility?
Member eligibility is available on-line at the following address:
www.ocmsipov.com
Note: Remember to enter either, the Member ID or the SSN to initiate the process.
10. Where do I submit claims?
Registered providers must submit claims for payment consideration to:
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Electronic claims submission is also available (and is preferred); for more information call: (800) 206-6591
11. Does MSI have a billing deadline?
Claims must be received by the Program’s current billing agent (AMM) 90 days from the date of service or 90 days from the date on the member’s NOA letter, whichever is later.
The MSI fiscal year is September 1st
through August 31st. The last day for submission of claims for
the fiscal year is November 30th.
12. Where do members obtain prescriptions?
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/medical/msi/providers/news.htm
Note: Medications must be obtained from pharmacies in Orange County
only.
13. Does the MSI program reimburse for services provided outside of Orange County?
MSI members must receive services within Orange County. In
rare instances, services may be 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.
Please refer to the Provider Manual for a comprehensive overview of the MSI program. The document is available on this website
(Provider Downloads/Alerts)
http://ochealthinfo.com/medical/msi/providers/news.htm
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