If CCS denies a service because it is not for the eligible condition, the provider may then need to seek authorization through the standard Medi-Cal process (e.g., via a Treatment Authorization Request).
Providers receive a Notice of Action (NOA) through the Provider Electronic Data Interchange (PEDI). 3. Key Considerations for Approval
CCS is usually the primary authorizer for the specific eligible condition. 123929
The denial must state the specific reason (e.g., "service does not treat the CCS eligible condition").
The provider submits a SAR via the CMS Net portal or through designated county forms. If CCS denies a service because it is
Families have the right to request a Fair Hearing or an informal grievance review if they disagree with the authorization decision. 5. Interaction with Medi-Cal For children who are dually eligible for Medi-Cal and CCS:
Section 123929 establishes that services provided to a child through the CCS program generally require from the department or its designated agency. This means that before a medical service, piece of equipment, or treatment is provided, a Service Authorization Request (SAR) must be submitted and approved. 2. The SAR Process Key Considerations for Approval CCS is usually the
While "prior" authorization is the rule, certain emergency services may be authorized retroactively if they meet specific criteria defined in the CCS Manual of Procedures. 4. Denials and Appeals If a SAR is denied under Section 123929: