Medical Services for Indigents (MSI) is a safety net program for
adult indigents between the ages of 21 to 64. A medical service shall be considered for
reimbursement under the program, if such medical service is required
for:
- Immediate treatment of life threatening and emergent conditions.
- Treatment for acute exacerbation's of chronic conditions that are potentially life threatening.
- Limited monitoring of chronic conditions that are potentially life threatening.
- Conditions that are left untreated would result in permanent
and significant impairment in function.
Provider Enrollment:
Physicians are required to enroll into the MSI program. The necessary form is available by clicking here, Provider Enrollment Form.
Where do I send claims?
Send claims to the MSI program's fiscal intermediary, Advanced Medical Management (AMM). The MSI claims address is:
MSI Program
c/o Advanced Medical Management
P.O.Box 30248
Long Beach, CA 90853
You may also visit the AMM website for additional contact and provider information. The link is: https://ochca.amm.cc/
Where can I get a Provider Manual?
Provider Manuals can be downloaded by using the following link http://www.ochealthinfo.com/medical/msi/providers/downloads.htm.
Is there a billing deadline?
Yes. Billing deadlines are related to fiscal years. Fiscal years run from July 1 through June 30 of any given year. Providers have up to 90 days after the date of service (DOS), or 90 days after the date of the Notice of Action (NOA) letter (whichever is greater), to submit claims. One exception will be EMSF claims where the patient becomes retroactively effective with MSI-then providers will have up to 150 days from the DOS or NOA to submit a claim. September 30 is the cut off for claims adjudicated within each fiscal year.
Do I need a pre-authorization number to schedule MSI eligibles for surgery?
MSI now has utilization management in place and this department will prior authorize certain
surgical procedures to ensure the MSI provider / hospital will be paid.
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 hospitals. (Contracted hospitals are listed in the MSI Provider Manual.)
Where do I send MSI eligibles for prescriptions?
Prescriptions may be obtained from participating contracted hospital pharmacies and Caremark participating pharmacies. It is strongly encouraged that providers use Caremark (changing to Rx America in July, 2007) contracted pharmacies to help the MSI Program monitor the established formulary.
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.
For Additional MSI Information:
Contact the MSI program at (714) 834-5211 or visit the website at http://www.ochealthinfo.com/medical/msi/index.htm.
