Under California law, the CMSP Governing Board is authorized to set payment rates for health care services covered under CMSP. The Governing Board sets these rates within the context of annual program revenues and expenditures. CMSP may change its payment rates to remain within its budget. Should payment rates be changed, participating medical and dental services providers shall be notified in advance by Advanced Medical Management of such rate changes. Pharmacies shall be notified by MedImpact Health Systems Inc of any pharmacy payment rate changes.
Payment rates for services provided to CMSP members are set by the Governing Board in accordance with the rates of payment policy. To download a copy of the Rates of Payment Policy (Amended 07/2023) click here.
Providers must accept CMSP payment as payment in full for services provided. When a CMSP recipient has other health coverage, providers are required to bill the insurance carrier first prior to billing CMSP or submit a denial letter from the carrier with the CMSP claim.
For medical and dental services, provider claims payment is administered by Advanced Medical Management. Please refer to the CMSP Provider Operations Manual (Section 8) for detailed instructions on electronic and paper claims submission, timely filing rules, and other important billing considerations. Providers can contact AMM at (877) 589-6807 for billing support.
MedImpact administers the CMSP prescription drug benefit program within benefit and pricing parameters set by the Governing Board. Retail pharmacies with billing questions should contact MedImpact at (800) 788-2949.
