MISP | FAQ

A: The Medically Indigent Services Program (MISP) was developed in Riverside County in 1983.  The program was designed to provide  assistance for the health needs of adults between the ages of 21 and 64.  This assistance program was designed to cover acute illnesses and medical care to prevent disability.  The goal of the program is to reduce costly hospitalization and increase the ability to work.

A: No, MISP is not health insurance.  It was created to meet the immediate needs of clients who suffer traumas or have other emergency needs.  Although the provision of indigent medical services is mandated by the State of California, the Riverside County Board of Supervisors directs the eligibility criteria and scope of services covered.

A: No, people linked to the Medi-Cal Program are not eligible for MISP.  In addition, Medi-Cal has more eligible providers than MISP.

A: There is a complete list of verifications on pages 1 and 2 of the MISP application.  You should try to bring all items that apply to you to your interview. 

A: You should go ahead and submit your application.  An MISP Eligibility Specialist will review your application and give you a complete list of items necessary to complete the eligibility process.  In most cases you will have 30 days from the date of application to turn in all verifications.

By Appointment – This is the best way if you are going to apply in person.  Since you are assigned a specific date and time, all you have to do is show up on time and you will be seen within 20 minutes of your appointment time.  Coming to the office to apply in person without an appointment does not guarantee you will be seen the same day and can result in lengthy wait times.

Walk In – A limited number of walk in appointments are available daily beginning at 7 a.m.  It is recommended that you make an appointment if you do not have medical care scheduled (ie, follow-up visits) or prescriptions to fill.  Priority is given to applicants seen in the Emergency Room that day, so other applicants may not be able to see a worker.  Walk In appointments will not be given for applicants who are returning with verifications or who already have eligibility for the day of the walk-in.

By Mail/FAX – MISP accepts applications and verifications by mail at P O Box 9610, Moreno Valley, CA  92552.  We also accept information by FAX at 951-486-4635. These options may be more convenient for those who have transportation issues or who live in the outlying areas of Riverside County.  Please be advised that processing of information received by FAX or mail can take up to 30 calendar days to process from the day we receive it.  We do not advise using this process if you need to seek immediate medical attention or if you have follow-up visits or prescriptions to fill within the next 30 days.

By Drop Off – If you cannot make an appointment or are unable to obtain a walk-in you may apply and/or turn in your verifications by dropping them off with the MISP receptionist.  You will be required to take a number from our take-a-ticket machine and the receptionist will collect your information when she calls your number.  The receptionist issues a receipt for all information that is dropped off, but is unable to evaluate the acceptability of any documents.  Information received by drop-off is processed within 10 calendar days and a notice is mailed to the applicant.  We do not advise using this process if you need to seek immediate medical attention or if you have follow-up visits or prescriptions to fill within the next 10 days.

A: This is the best way if you are going to apply in person.  Since you are assigned a specific date and time, all you have to do is show up on time and you will be seen within 20 minutes of your appointment time.  Coming to the office to apply in person without an appointment does not guarantee you will be seen the same day and can result in lengthy wait times.

A: To obtain MISP eligibility an applicant must have a combined household income and assets less than 200% of the Federal Poverty Level and:

     1.     Be able to show proof that he/she is a legal resident of Riverside County for more than 30 days
     2.     Must complete an MISP application form
     3.     Must be an adult between the ages of 21 to 64
     4.     Must not be insured or have access to a health plan
     5.     Must be able to show proof of income and assets
     6.     Must show proof of identity
     7      Must not have a valid Visitor’s visa
     8.     Must not be in Riverside County for the sole purpose of rehabilitation
     9.     Client must not be institutionalized in Skilled Nursing Home (SNF) or Institution for Mentally Disabled (IMD)

A: MISP can only be accessed after you have exhausted all other coverage options, including Medi-Cal, Social Security Disability (SSD) and Supplemental Security Income (SSI).  All applicants who have a disabling condition expected to last more than 1 year or who have already been disabled more than 1 year may be eligible for one or all of these programs.  For this reason, MISP requires that you apply for all programs that you may qualify for as a condition of your continued MISP eligibility.

A: MISP issues a disability pending eligibility status to all applicants who meet the MISP eligibility criteria and have applied for Medi-Cal, SSD, and/or SSI.  This means that for the purpose of receiving your medical services Medi-Cal is considered your primary payer until a decision is made on the case.  It also means that your bills are placed in a holding pattern until the case is settled.  However, RCRMC Patient Accounts will not send your bill to collections while this process is pending.  Please note that you must comply with all requirements for these programs as a condition of retaining MISP coverage.

A: There is no time limit for MISP; however, MISP is not intended to be a permanent solution for health care coverage.  In addition, you must apply for any health care coverage including health insurance, Medi-Cal, and any other health care program available to you before you apply for MISP.  All applicants must complete a new application and re-verification of all items at least annually.

A: MISP eligibility can be approved for as little as one month or as long as 1 year, depending on your circumstances.  The Eligibility Specialist will grant the longest time possible in each case on the condition that any changes in your current situation be reported within 10 days of their occurrence.

A: Depending on your income, you may qualify with a share of cost.  You pay the share of cost for each month you receive medical care (including prescriptions).  If the medical care provided for the month is less than the share of cost, you only pay the amount due for the medical care provided.  You do not pay in months that you do not receive medical care.  If you are given a share of cost, the amount will be disclosed to you at the time your application is evaluated.

In addition to a share of cost, all applicants must pay co-pays.  (Including applicants who qualify with no share of cost)  The co-pays are $10 for the Emergency Room, $5 for Outpatient visits (clinic), and $2 per prescription.  These co-pays are ordered by the Riverside County Board of Supervisors and cannot be waived by MISP personnel or RCRMC staff.

A: An applicant must have a combined household income and assets less than 200% of the Federal Poverty Level and

A: You may still qualify, depending on the amount of income you are earning from the job and if your employer does not offer you health insurance.

A: MISP does not notify members when their eligibility is running out.  Applicants should re-apply in the last month of their eligibility if they continue to need medical care.

A: No, you must have a current medical need and/ or have prescriptions that need to be filled to apply for MISP.   You may also apply if you have received emergency medical care within the last 30 days.

A: No, you must obtain your health care from Riverside County Regional Medical Center, one of the Riverside County Community Health Centers, or one of our Contracted Health Centers.  A complete list of eligible providers is on page two of your MISP brochure.

A: MISP covers medically necessary services that are required to prevent further disability or death.  MISP does not cover preventative care or any service not covered by Medi-Cal.  MISP does not cover services related to pregnancy or mental health

A: MISP covers prescriptions that are on the Medi-Cal formulary that are filled at authorized pharmacies.  MISP does not cover pregnancy related prescriptions or mental health prescriptions or prescription that require prior authorization.

Q: Where can I get my prescriptions filled?

A: If you receive a prescription from Riverside County Regional Medical Center or at Riverside Neighborhood Health Center the prescriptions must be fill at the pharmacy located at the facility. Otherwise, the prescription can be filled at an authorized pharmacy.

A: MISP is limited to medical services.  Please contact Riverside County Mental Health Department for assistance with mental health services and prescriptions.  A list of phone numbers is provided on page 2 of your MISP brochure.

A: Dental services are limited to medically necessary extractions only.  No other dental services are covered.

A: A complete list of authorized dentists is listed on page 2 of your MISP brochure.

A: There are currently no dental services available at Riverside County Regional Medical Center.

A: They may not be aware that you are eligible for the program.  Make sure the provider is aware by providing them with a copy of your MISP Membership Slip.  (Make sure you were eligible for the service date being billed.) 

Another reason may be that the program did not cover the services you received.  This happens most frequently when a member receives services at a hospital emergency room that were not life-threatening or services were received at a facility that is not contracted. 

A: While you are in a disability pending status, your claims may not get paid and you may receive bills.  Keeping the provider informed of your current status each time you receive a bill will usually keep the bill from going to collections.  Riverside County Regional Medical Center will not send your bill to collections while you are pending disability.

Q: If disability is pending, when will the provider get paid?  How long will it take?

A: The provider will be paid if you are denied by all disability programs for the reason of not being disabled.  If you are denied for another reason, your MISP may be denied and you may become responsible for the bills you incur.  The most common reason this occurs is failure to comply with requests made by the disability program you are applying for.

The program you are applying for determines the length of time it takes to make the disability determination.  MISP cannot determine this.

A: MISP receives a limited amount of funding each year.  This funding is used to pay for all of the medical care provided to our members.  The funding does not currently cover all of the care that is provided.

A: MISP does not cover any services received outside Riverside County.

PROVIDER INFORMATION

A: Claims must be submitted on claim form UB-92 or claim form HCFA-1500.

• Applicable Reports Must be Attached: 
• Emergency Room — Emergency Room Report
  
• Procedures — Operative Report
  
• Supplies — Purchase Invoice
  
• Ambulance — EMS Run Sheet
  
• MISP — Request Referral Form (RRF)

Additional information may be requested if necessary to determine claim eligibility and/or payment amount.

Q: What type of claims would be eligibility for MISP reimbursement?

A: Patient must have active MISP eligibility for the date of service.  It is the responsibility of the treatment provider to ensure that the client does not have Medi-Cal, Medicare, or other health coverage and bill these programs prior to billing MISP.  Clients who qualify for Medi-Cal, Medicare, or other Health Care coverage do not qualify for MISP.

The service must be rendered at a MISP CONTRACTED HOSPITAL within Riverside County and meet MISP criteria as a life-threatening emergency

OR

The service must be pre-authorized by MISP on an official MISP Request Referral Form (RRF).

OR

The service must be rendered at Riverside County Regional Medical Center, a Riverside County Health Center, or a MISP contracted community health center

OR

The service must be an ambulance transport by a MISP CONTRACTED AMBULANCE provider and meet MISP criteria as an eligible transport.

Q: Where do I mail a claim for reimbursement?

A: FIS/MISP Claims Processing                 
PO Box 9610                                                  
Moreno Valley, CA  92552-9610   

A: Yes, All appeals of payment and/or denial of claims must be submitted in writing and received by FIS through U.S. mail, or by fax, within sixty (60) calendar days from the date printed on the explanation of benefits (EOB) that reported the particular denial.  The appeal packet must include:

1. a copy of billing documents (e.g. claim form UB-92 or claim form HCFA-1500) under dispute with billing notes, and
2. a letter describing the argument for the appeal.

All appeals must be addressed to the address listed above.  Upon evaluation of your appeal, FIS will notify you within fifteen (15) business days in writing, or by fax, followed by a mailed original outlining the disposition of your appeal.

Q: How do I find out the status of my claims?

MISP will mail out an Explanation of Benefits for all claims received.

Q: Will the County Warrant come with the Explanation of Benefits?

A: No. The Explanation of Benefits is mail out prior to the mailing of the County Warrant

Q: What happens if I cannot find my Explanation of Benefits once I receive the County Warrant?

A: Your may request a duplicate copy of the Explanation of Benefits by faxing a copy of the County Warrant to MISP at (951) 486-4655. Be sure to include your name, address, and phone number on the request.

Q: I received an Explanation of Benefits that state the Claim was denied as duplicate however; we never received the first notice.

A: You can request a duplicate copy of the first Explanations for Benefits by faxing the 2nd Explanation of Benefits and stating you need a duplicate of the first.