Provider FAQ's
- How do I become an enrolled CMSP provider?
- How do I provide services to CMSP beneficiaries?
- How do I bill for services provided to CMSP beneficiaries?
- What are the reimbursement rates for services provided to CMSP beneficiaries?
- Does CMSP have the same scope of services as Medi-Cal?
- How many participating counties participate in CMSP?
- Whom can I contact on questions regarding billing problems for medical services?
- Where can I refer a CMSP member with questions regarding CMSP?
- Who can I contact with questions regarding dental billing questions?
- Where can I refer a beneficiary with questions on dental services?
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/Anthem
Blue Cross provider network. To become a part of the network, you must
execute a provider agreement with Anthem Blue Cross Life & Health
Insurance Company. For further information regarding becoming a part
of the network, contact Anthem Blue Cross Life & Health Insurance Company
Network Development at (866) 841-8950. 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/Anthem Blue Cross 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 Anthem Blue Cross.
How do I bill for services provided to CMSP beneficiaries?
Billing to Anthem Blue Cross for health care services is done in accordance
with billing rules described in the CMSP/Anthem Blue Cross POM that
is provided to all network providers. Hospitals and FQHC/RHC clinics
use the UB-92 form. Medical groups and individual physicians utilize
the CMS 1500 form.
What are the reimbursement rates for services provided to CMSP beneficiaries?
Anthem Blue Cross 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?
34 counties participate. To receive CMSP benefits, the beneficiary must reside in one of the 34 counties.
Whom can I contact on questions regarding billing problems for medical services?
Providers can contact
the Anthem Blue Cross Customer Care Center (CCC) at (800) 670-6133.
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 the Anthem Blue Cross CCC at (800) 670-6133.
Who can I contact with questions regarding dental billing questions?
Providers can contact the Anthem Blue Cross CCC at (800) 670-6133.
Where can I refer a beneficiary with questions on dental services?
CMSP members may call the Anthem Blue Cross CCC
at (800) 670-6133.