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Where do I send claims?
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Where can I get a Provider Manual?
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Is there a billing deadline?
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Does MSI have a Utilization Management Department (UMD)?-
Do I need to contact UMD to schedule MSI eligibles for surgery?
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Where do I send MSI eligibles for diagnostic testing and other
outpatient procedures?
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Where do I send MSI eligibles for prescriptions?
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May I refer MSI eligibles to providers outside of Orange County?
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Does a provider have to be contracted with the MSI Program to see
MSI patients?
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What is the reimbursement schedule for the MSI program?
1.Where do I send claims?
Only registered providers may submit claims for payment consideration to the MSI
program.
All claims for MSI services
must be submitted to the current fiscal intermediary, Advanced
Medical Management, Inc. (AMM). The address is:
AMM
Attn: MSI Program
P.O. Box 30248
Long Beach, CA. 90853
Electronic claims submission is available.
Contact AMM at 1-800-206-6591 for more information about
electronic claims submission.
2. Where can I get a Provider Manual?
Provider Manuals may
be viewed on this website. Click
here to view.
3. Is there a billing deadline?
The
timeline for claims submission is 90 days from the date of service
or from the date on the Notice of Action letter (NOA), whichever
is later. The final date for claims receipt by the Fiscal
Intermediary is now November 30, 2007 - 90 days following the last date
for service within this contract period. Please be aware the final
billing date has been moved up from previous year's
contracts. Physicians may use their own billing statements or the
CMS 1500. All billing must include the following information:
Electronic claims submission is available.
Contact AMM at 1-800-206-6591 for more information about
electronic claims submission.
4. Does MSI have a Utilization Management Department (UMD)?
Yes. The MSI Program assigns tracking numbers on outpatient
services, Durable Medical Equipment (DME), and Home Health (HH)
visits. Tracking numbers are given by MSI - UMD by calling (714)
634-5169, ext. 243. For a complete list of outpatient services
available, please refer to the Outpatient Contracted Services List
in the Provider Download section of site web site.
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5. Do I need to
contact UMD to schedule MSI eligibles for surgery?
No. The MSI program uses a retrospective review
system for claims evaluation and reimbursement. Scope of Service
guidelines are outlined in the MSI program's
Provider Manual.
6. Where do I send MSI eligibles for
diagnostic testing and other
outpatient procedures?
All diagnostic testing and other outpatient
procedures must be rendered at MSI contracted facilities. Unilab/Quest
Diagnostics is now contracted for outpatient laboratory services.
New contracts for other outpatient diagnostic procedures have been
posted in the Outpatient Contracted Services List in the
Provider
Download section of this web site.
7. Where do I send MSI eligibles for
prescriptions?
Prescriptions must be obtained from
participating contracted
RxAmerica pharmacies.
Click here to view
pharmacy listing.
8. May I refer MSI eligibles to providers
outside of Orange County?
All services for MSI recipients must be rendered
within Orange County. However, if the service falls within the MSI
program's Scope of Service, and the service in question cannot be
obtained within Orange County, it may be reimbursable subject to
retrospective review by the MSI program's Medical Review
Committee.
No, however, physicians must complete the online MSI
physician registration to be paid for services that are
within the program’s scope.
10. What is the
reimbursement schedule for the MSI program?
As a result of an increase in funding in Fiscal Year 2006-2007, the initial payment for physician providers will be increased from seventy percent (70%) to eighty-five (85%) of the national average Medicare fee schedule. At the end of the fiscal year, final settlement will occur and any remaining funds will be equally distributed to all providers.
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