CMISP Procedure Authorization Instructions


REQUEST FOR ADDITIONAL AUTHORIZATION - PRIOR AUTHORIZATION
 
Case Management Authorization is required:
 
  • For additional billable visits or procedures not on the Procedure Authorization Form (PAF)
  • If the date of service is other than that indicated on the PAF.
  • For surgical procedures.
The request for authorization must be submitted in writing prior to being scheduled. A printed PAF will not be sent when the additional service is added to an already authorized package.
 
LABORATORY TESTS
Send ALL laboratory procedure requests to Quest Diagnostics.  
 
PHARMACEUTICALS
Prescriptions are filled at the County Pharmacy, 4600 Broadway, Monday through Friday, 8:00 a.m to 5:00 p.m, telephone (916) 874-9220. Other locations are available for special circumstances. 
 
RADIOLOGY, DIAGNOSTIC, AND DME
All Radiology, Diagnostic, and DME services are authorized and arranged through CMISP Medical Case Management. CMISP Case Management will schedule all authorized diagnostic tests which do not require the presence of the physician. The physician's office staff may schedule authorized tests which do require the physician's presence.  Plan films generally will be done at the Primary Care Clinic.
 
CALLING IN ANOTHER CONSULTANT
Prior authorization from Medical Case Management must be obtained before calling in another consultant. If another physician covered for the CMISP authorized physician OR the patient was referred to another physician due to an urgent situation, notify Medical Case Management the next working day.
 
MEDICAL REPORTS
Send copies of medical records and reports to Medical Case Management.
 
CLAIMS
Use your Medi-Cal form to bill CMISP. Send the completed billing form to DHHS Fiscal Services.  Please DO NOT send your bill to Medical Case Management.


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