Frequently Asked Questions
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Provider FAQ's

A Beaker with a Monitor.

How do I become an enrolled CMSP provider?
If you are interested in providing health care services to CMSP members, you must be a part of the CMSP provider network. To become a part of the network, you must execute a provider agreement with the CMSP Governing Board. For further information regarding becoming a part of the network, contact Advanced Medical Management at (877) 589-6807. In addition, participating providers are expected to be enrolled in the Medi-Cal program as a Medi-Cal provider. This will assist you in verifying CMSP eligibility and CMSP member Share-of-Cost because the mechanisms used by CMSP for these purposes (POS, phone AEVS, and the Internet) are the same as those used for Medi-Cal.

How do I provide services to CMSP beneficiaries?
Services for CMSP beneficiaries are provided in accordance with the CMSP Provider Operations Manual (POM), which is provided to all providers participating in the network. Primary care services and most specialty care services do not require pre-service review. Specified services, including ambulatory surgery, home infusion therapy, durable medical equipment and various other services require pre-service review. Pre-service review must be obtained from AMM.

How do I bill for services provided to CMSP beneficiaries?
Billing to AMM for health care services is done in accordance with billing rules described in the CMSP POM that is provided to all network providers. Hospitals and FQHC/RHC clinics use the UB-04 form. Medical groups and individual physicians utilize the CMS 1500 form.

What are the reimbursement rates for services provided to CMSP beneficiaries?
AMM administers CMSP in accordance with payment levels set by the Governing Board and approved under the Board's CMSP Rates of Payment Policy.

Does CMSP have the same scope of services as Medi-Cal?
No. Please see our Benefits listing for a complete list of CMSP covered benefits.

How many participating counties participate in CMSP?
35 counties participate. To receive CMSP benefits, the beneficiary must reside in one of the 35 counties.

CMSP Participating Counties

Who can I contact with questions regarding medical billing for CMSP services?
Providers can contact AMM at (877) 589-6807.

Where can I refer a CMSP member with questions regarding CMSP?
For further information about CMSP eligibility, CMSP members are encouraged to contact their county eligibility worker. For information regarding covered benefits or assistance finding a provider, CMSP members may call AMM at (877) 589-6807.

Who can I contact with questions regarding dental billing for CMSP services?
Providers can contact the Anthem Blue Cross CCC at (800) 670-6133 for dates of service prior to April 1, 2015. Contact AMM at (877) 589-6807 for dates of service on or after April 1, 2015..

Where can I refer a beneficiary with questions on dental services?
CMSP members may call AMM at (877) 589-6807

 

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