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?
Beginning October 1, 2005, 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?
Beginning October 1, 2005, services for CMSP beneficiaries will be 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 will not require
pre-service review. Specified services, including ambulatory surgery,
home infusion therapy, durable medical equipment and various other services
will require pre-service review. Pre-service review must be obtained
from Anthem Blue Cross.
How do I bill for services provided to CMSP beneficiaries?
Beginning October 1, 2005, billing to Anthem Blue Cross for health care
services will be 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. For most outpatient services, CMSP rates are
typically 10% below current Medi-Cal payment levels. Inpatient hospital
services are 15% below the current Medi-Cal payment level, and payment
is based upon a percent of charges methodology that takes into consideration
the hospital's prior percentage of paid to billed charges, adjusted
for prior year over- and under- payments. CMSP payment levels under
program administration by Anthem Blue Cross are consistent with those
provided under CMSP when it was administered by the Department of Health
Services under Medi-Cal Fee-For-Service rules.
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?
For services provided on or before September 30, 2005, contact EDS at
(800) 541-5555.
For services provided on or after October 1, 2005, providers will 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?
For services provided on or before September 30, 2005, providers can
contact Denti-Cal at (800) 423-0507. Federally Qualified Health Centers,
Rural Health Clinics, and Tribal Health Programs providers should contact
EDS at (800) 541-5555. For services provided on or after October 1,
2005, providers can contact the Anthem Blue Cross CCC at (800) 670-6133.
Where can I refer a beneficiary with questions on dental services?
For services provided on or before September 30, 2005, CMSP members
can contact Denti-Cal at (800) 322-6384. For services provided on or
after October 1, 2005, CMSP members may call the Anthem Blue Cross CCC
at (800) 670-6133.