Eligibility is generally effective for twelve months. Members may reapply in their twelfth month of eligibility (only if a medical condition still exists). It is recommended that members call for an appointment early in their eleventh month of eligibility.
The application is reviewed by the MSI program's Social Services Agency (SSA). This process takes approximately four-six weeks from the date of application. Questions about the status of an application should be referred to the SSA Eligibility Information Line at (866) 979-6772.
All MSI members are required to have a Primary Care Physician (PCP) also known as a Medical Home.
Once eligibility is confirmed, Member's should call the MSI program's Patient Education Department (PED) at (800) 417-4262 Option 1 to request a PCP. The PCP is selected from a specific list of physicians in private practice, and community clinics.
Note: If you would like to continue with a physician you were assigned in a prior eligibility period, you may request the same assignment, provided the physician is still available.
Where do I obtain medical services if my PCP's office is closed or I cannot get a timely appointment?
Urgent Care Centers and CVS Minute clinics are available for medical conditions that are not of a serious nature but require evaluation within a few days. A list of these facilities is available in the Member Handbook. Life or limb threatening conditions should be evaluated in the Emergency Department (ED); always access the closest ED in these situations.
Note: The MSI program's Nurse Line at (800) 381-9221 is also available (24/7) to discuss a medical concern
Requests for physician specialty services must be coordinated through the member's PCP, and are approved by the MSI program's Authorization Department. Refer to the Member Handbook for additional information on this process.
Where do I go for lab work and other diagnostic procedures?
Laboratory services are provided through Quest diagnostics; for a list of service locations call (800) 377-8448. All other diagnostic services including, MRI, CT scan, PET scan, ultrasound and general X-ray must be provided through MSI contracted facilities (a list of these locations is available in the Member Handbook under Outpatient services).
Note:All diagnostic services must have a written order from a physician, nurse practitioner or physician assistant.
What do I do with the bills I receive from physicians, hospitals and other providers of service?
Providers of service often bill members because they are not aware of the member's MSI eligibility. It is the member's responsibility to inform all providers of their MSI eligibility status. It is a good idea to photocopy the NOA letter, and send a copy to each provider.
Providers must bill the MSI program within 90 days of the date the service was received or 90 days from the date on the NOA letter, whichever, is later.
Note:Members may be responsible for payment if they fail to notify providers of their MSI eligibility status
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